Page 53 - 51 the significance--29.2_opt

The future of managing T2DM patients with declining renal
function

In view of the limitations of the current therapies when it comes to man-
aging T2DM patients with declining renal function, there is a pressing
need for antihyperglycaemic agents that can be used safely and with-
out dose adjustment or additional drug-related monitoring in this pa-
tient population. We need to remember this is by no means a small pro-
portion of the total T2DM population, so any new treatments that fulfil
these criteria have the potential to benefit a huge number of people.
There are a number of promising new treatment options for T2DM on
the horizon and some of these belong to established OAD classes, yet
they offer the advantage of being safe to use without dose reduction in
patients with kidney disease. These new treatments and an increased
accuracy in phenotyping the patient with T2DM will be instrumental in
individualising the management of this chronic disease.

Chapter 3 Summary

z Declining renal function has a significant impact on the way that T2DM is
managed.
z T2DM patients with impaired renal function are at a 240% higher risk of
hypoglycaemia compared with those patients with normal renal function.
z The kidneys play a critical role in the clearance and degradation of insulin
and most antidiabetic agents
z This is particular problem with antidiabetic agents that stimulate the release
of insulin.
z KDOQI guidelines recommend a target HbA level of <7% regardless of
1c
whether a patient has renal impairment or is on dialysis.
z HbA is accurate for monitoring blood glucose control, even in patients
1c
with declining renal function, although there are still concerns in dialysis
patients.
z The majority of drugs available to treat hyperglycaemia are affected by
kidney function and therefore should be either avoided or used in reduced
doses for patients with CKD.
z Some new antidiabetics can be used safely in renal impairment and dialysis,
as they are not eliminated by the kidneys.

z Current therapies for T2DM have many limitations, especially when it comes
to treating T2DM patients with comorbidities.
z New therapies that lower blood glucose levels safely in patients with declining
renal function have the potential to benefit a huge number of people.

53