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Diabetic kidney disease: update on clinical management and non-glycaemic effects of newer medications for type 2 diabetes

Type 2 diabetes is a leading cause of chronic kidney disease worldwide and continues to increase in prevalence. This in turn has significant implications for healthcare provision and the economy. In recent years there have been multiple advances in the glucose-lowering agents available for the treat...

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Autores principales: de Bhailís, Áine M., Azmi, Shazli, Kalra, Philip A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165820/
https://www.ncbi.nlm.nih.gov/pubmed/34104399
http://dx.doi.org/10.1177/20420188211020664
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author de Bhailís, Áine M.
Azmi, Shazli
Kalra, Philip A.
author_facet de Bhailís, Áine M.
Azmi, Shazli
Kalra, Philip A.
author_sort de Bhailís, Áine M.
collection PubMed
description Type 2 diabetes is a leading cause of chronic kidney disease worldwide and continues to increase in prevalence. This in turn has significant implications for healthcare provision and the economy. In recent years there have been multiple advances in the glucose-lowering agents available for the treatment of diabetes, which not only modify the disease itself but also have important benefits in terms of the associated cardiovascular outcomes. The cardiovascular outcome trials of agents such as glucagon-like peptide-1 receptor agonists (GLP-RAs) and sodium glucose cotransporter 2 inhibitors (SGLT-2) have demonstrated significant benefits in reducing major adverse cardiovascular events, admissions for heart failure and in some cases mortality. Secondary analysis of these trials has also indicated significant renoprotective benefit. Canagliflozin and Renal Outcomes in Type 2 Diabetes Mellitus and Nephropathy (CREDENCE) a renal-specific trial, has shown major benefits with canagliflozin for renal outcomes in diabetic kidney disease, and similar trials with other SGLT-2 inhibitors are either underway or awaiting analysis. In this article we review current goals of treatment of diabetes and the implications of advancing renal impairment on choice of treatments. Areas discussed include the diagnosis of diabetic kidney disease and current treatment strategies for diabetic kidney disease ranging from lifestyle modifications to glycaemic control. This review focuses on the role of GLP-RAs and SGLT-2 inhibitors in treating those with diabetes and chronic kidney disease with some illustrative cases. It is clear that these agents should now be considered first choice in combination with metformin in those with diabetes and increased cardiovascular risk and/or reduced renal function, and in preference to other classes such as dipeptidyl peptidase-4 (DPP-4) inhibitors or sulphonylureas.
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spelling pubmed-81658202021-06-07 Diabetic kidney disease: update on clinical management and non-glycaemic effects of newer medications for type 2 diabetes de Bhailís, Áine M. Azmi, Shazli Kalra, Philip A. Ther Adv Endocrinol Metab Diabetic Kidney Disease: Pathogenesis and Therapeutic Targets Type 2 diabetes is a leading cause of chronic kidney disease worldwide and continues to increase in prevalence. This in turn has significant implications for healthcare provision and the economy. In recent years there have been multiple advances in the glucose-lowering agents available for the treatment of diabetes, which not only modify the disease itself but also have important benefits in terms of the associated cardiovascular outcomes. The cardiovascular outcome trials of agents such as glucagon-like peptide-1 receptor agonists (GLP-RAs) and sodium glucose cotransporter 2 inhibitors (SGLT-2) have demonstrated significant benefits in reducing major adverse cardiovascular events, admissions for heart failure and in some cases mortality. Secondary analysis of these trials has also indicated significant renoprotective benefit. Canagliflozin and Renal Outcomes in Type 2 Diabetes Mellitus and Nephropathy (CREDENCE) a renal-specific trial, has shown major benefits with canagliflozin for renal outcomes in diabetic kidney disease, and similar trials with other SGLT-2 inhibitors are either underway or awaiting analysis. In this article we review current goals of treatment of diabetes and the implications of advancing renal impairment on choice of treatments. Areas discussed include the diagnosis of diabetic kidney disease and current treatment strategies for diabetic kidney disease ranging from lifestyle modifications to glycaemic control. This review focuses on the role of GLP-RAs and SGLT-2 inhibitors in treating those with diabetes and chronic kidney disease with some illustrative cases. It is clear that these agents should now be considered first choice in combination with metformin in those with diabetes and increased cardiovascular risk and/or reduced renal function, and in preference to other classes such as dipeptidyl peptidase-4 (DPP-4) inhibitors or sulphonylureas. SAGE Publications 2021-05-29 /pmc/articles/PMC8165820/ /pubmed/34104399 http://dx.doi.org/10.1177/20420188211020664 Text en © The Author(s), 2021 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Diabetic Kidney Disease: Pathogenesis and Therapeutic Targets
de Bhailís, Áine M.
Azmi, Shazli
Kalra, Philip A.
Diabetic kidney disease: update on clinical management and non-glycaemic effects of newer medications for type 2 diabetes
title Diabetic kidney disease: update on clinical management and non-glycaemic effects of newer medications for type 2 diabetes
title_full Diabetic kidney disease: update on clinical management and non-glycaemic effects of newer medications for type 2 diabetes
title_fullStr Diabetic kidney disease: update on clinical management and non-glycaemic effects of newer medications for type 2 diabetes
title_full_unstemmed Diabetic kidney disease: update on clinical management and non-glycaemic effects of newer medications for type 2 diabetes
title_short Diabetic kidney disease: update on clinical management and non-glycaemic effects of newer medications for type 2 diabetes
title_sort diabetic kidney disease: update on clinical management and non-glycaemic effects of newer medications for type 2 diabetes
topic Diabetic Kidney Disease: Pathogenesis and Therapeutic Targets
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165820/
https://www.ncbi.nlm.nih.gov/pubmed/34104399
http://dx.doi.org/10.1177/20420188211020664
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