Diabetes Management in Chronic Kidney Disease
Summary
Diabetes management in the context of chronic kidney disease (CKD) requires a nuanced balance of glycaemic control and preservation of renal function. Progressive decline in glomerular filtration alters the pharmacokinetics of oral and injectable antidiabetic agents, heightening the risk of both hyperglycaemia and hypoglycaemia. A patient-centred approach emphasises individualised glycaemic targets, accounting for comorbid cardiovascular disease, frailty and life expectancy. Emerging evidence supports the renal and cardiovascular benefits of sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, which may slow CKD progression and reduce adverse events. Insulin remains a cornerstone for those with advanced renal impairment, but dose adjustments and vigilant monitoring are essential to avert hypoglycaemic episodes. Multidisciplinary collaboration, encompassing nephrology, endocrinology and diabetes education, underpins optimal outcomes. The global burden of diabetic kidney disease underscores the need for scalable care models and equitable access to novel therapies, especially in resource-limited settings.
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Diabetes Management in Chronic Kidney Disease publication trend
The graph below shows the total number of articles in diabetes management in chronic kidney disease across all publications each year (not limited to Nature Index journals).
Technical terms
Chronic Kidney Disease (CKD): progressive loss of renal function characterised by sustained reduction in glomerular filtration rate over at least three months.
Diabetic Kidney Disease (DKD): a form of CKD resulting from long-standing hyperglycaemia, marked by albuminuria and declining filtration capacity.
Estimated Glomerular Filtration Rate (eGFR): a calculated index of renal function based on serum creatinine, age and sex.
Glycaemic Control: the process of maintaining blood glucose within defined target ranges to minimise complications.
Hypoglycaemia: an abnormally low blood glucose level that can provoke neuroglycopenic and cardiovascular events.
Basal Insulin: a long-acting insulin formulation administered to sustain background glucose regulation independent of meals.
References
- Management of diabetes mellitus in individuals with chronic kidney disease: therapeutic perspectives and glycemic control. Clinics (2016).
- Insulin use in chronic kidney disease and the risk of hypoglycemic events. BMC Nephrology (2022).
- A Retrospective Observational Study of Insulin Glargine in Type 2 Diabetic Patients with Advanced Chronic Kidney Disease. Cureus (2019).
- Compliance with Prescription Guidelines for Glucose-Lowering Therapies According to Renal Function: Real-Life Study in Inpatients of Internal Medicine, Endocrinology and Cardiology Units. Medicina (2021).
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