Pharmacotherapy for Diabetes in Chronic Kidney Disease: A Basic Overview

Abstract

Diabetes mellitus (DM) is one of the most common causes and comorbidities in chronic kidney disease (CKD) globally. Particularly, DM in CKD patients increases the overall risk for kidney failure, atherosclerotic cardiovascular disease, heart failure, and premature mortality. Recent clinical studies support new approaches to treat diabetes and CKD. Recent clinical practice guidelines provide evidence-based recommendations for screening and diagnosis, monitoring of glycemia with individualized glycated hemoglobin (HbA1c) targets, and reduction of cardiovascular disease risk. Besides, various holistic approaches, treatment goals, and pharmacological and non-pharmacologic management of DM in CKD patients are also reported. The present review emphasizes pharmacotherapy for DM targeting individual goals of managing hyperglycemia, achieving HbA1c targets, improving kidney and cardiovascular outcomes, and reducing severe complications. Various pharmacotherapeutic choices for managing hyperglycemia and HbA1c include the use of various insulin formulations and delivery modifications. Especially, the focus is on the use of first-line agents, metformin and sodium-glucose cotransporter-2 inhibitors, and the second-line agents, glucagon-like peptide-1 receptor agonists, for additional benefits of cardiorenal protection and reducing the risk of cardiovascular disease, in addition to managing hypoglycemia. Furthermore, significant evidence-based advancements in the management of DM in CKD patients are discussed.