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NDT Advance Access originally published online on November 17, 2008
Nephrology Dialysis Transplantation 2009 24(2):338-341; doi:10.1093/ndt/gfn616
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Which hypoglycaemic agents to use in type 2 diabetic subjects with CKD and how?*

Masakazu Haneda1 and Akizuki Morikawa2

1 Department of Medicine, Division of Metabolism and Biosystemic Science, Asahikawa Medical College 2 Asahikawa Red Cross Hospital, Asahikawa, Hokkaido, Japan

Correspondence and offprint requests to: Masakazu Haneda, Department of Medicine, Division of Metabolism and Biosystemic Science, Asahikawa Medical College, Midorigaokahigashi 2-1-1-1, Asahikawa, Hokkaido 078-8510, Japan. Tel: +81-166-68-2450; Fax: +81-166-68-2459; E-mail: haneda@asahikawa-med.ac.jp

Keywords: diabetes mellitus; diabetic nephropathy; glycated albumin; HbA1c; hypoglycaemia

The first 150 words of the full text of this article appear below.

DCCT [1], UKPDS [2,3] and Kumamoto studies [4] clearly indicate that good glycaemic control can reduce the risk of nephropathy in subjects with both type 1 and type 2 diabetes. Furthermore, the recent ADVANCE trial confirmed that much tighter glycaemic control (mean HbA1c = 6.5%) is beneficial for nephropathy in subjects with type 2 diabetes [5]. In order to achieve tight glycaemic control, we would like to try to describe which hypoglycaemic agents to use in type 2 diabetic subjects with CKD and how, in this comment.



   Type 2 diabetic subjects with CKD stage 1 or 2
 
There is no limitation to use any hypoglycaemic agent in this stage of subjects. However, from UKPDS, it was suggested to start with metformin for obese subjects and sulfonylureas for non-obese subjects [2,3]. This concept was used in Steno-2 trials for type 2 diabetic subjects with microalbuminuria [6]. In 2006, a . . . [Full Text of this Article]



   Type 2 diabetic subjects with CKD stages 3–5
 
Insulin secretagogues
Sulfonylureas
Glinides
Incretin-based insulin secretagogues
Insulin sensitizer
Biguanides
Thiazolidinediones
{alpha}-Glucosidase inhibitors
Insulin
How to evaluate the status of glycaemic control in subjects with ESRD


   Conclusion
 

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