The purpose of this study was to evaluate the
therapeutic options for diabetes
treatment and their potential side effects, in addition to analyzing the
risks and benefits of tight
glycemic control in
patients with
diabetic kidney disease. For this
review, a search was performed using several pre-defined
keyword combinations and their equivalents “diabetes
kidney disease” and “
renal failure” in combination with “diabetes
treatment” and “oral
antidiabetic drugs” or “oral
hypoglycemic agents.” The search was performed in
PubMed, Endocrine Abstracts and the Cochrane
Library from January 1980 up to January 2015. Diabetes
treatment in
patients with
diabetic kidney disease is challenging, in part because of progression of
renal failure-related changes in
insulin signaling,
glucose transport and
metabolism, favoring both hyperglycemic peaks and
hypoglycemia. Additionally, the decline in renal function impairs the clearance and
metabolism of
antidiabetic agents and
insulin, frequently requiring reassessment of
prescriptions. The management of
hyperglycemia in
patients with
diabetic kidney disease is even more difficult, requiring
adjustment of
antidiabetic agents and
insulin doses. The
health team responsible for the follow-up of these
patients should be vigilant and prepared to make such changes; however, unfortunately, there are few guidelines addressing the nuances of the management of this specific
population.