Open AccessChallenges in achieving optimal glycemic control in type 2 diabetes patients with declining renal function: The Southeast A sia perspective
Author(s) -
CC Chow Francis,
Chan SiewPheng,
Hwu ChiiMin,
Suwanwalaikorn Sompongse,
Wu Akira YT,
Gan Susan Yu,
Zacarias Manuel B
Publication year - 2012
Publication title -
journal of diabetes investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.089
H-Index - 50
eISSN - 2040-1124
pISSN - 2040-1116
DOI - 10.1111/jdi.12006
Subject(s) - medicine , glycemic , diabetes mellitus , type 2 diabetes , metformin , kidney disease , linagliptin , macrovascular disease , intensive care medicine , renal function , disease , endocrinology
Abstract It is well recognised that A sia is at the epicenter of the global type 2 diabetes epidemic. Driven by socioeconomic changes involving industrialization, urbanization and adoption of W estern lifestyles, the unprecedented increases in the prevalence of diabetes are particularly evident in Southeast A sia. The impact of diabetes is immense, and despite evidence of the benefit of optimal glucose control in reducing the risk of disease progression and development of macrovascular and microvascular complications, many individuals in this region remain poorly controlled. Chronic kidney disease ( CKD ) is an increasingly common diabetes‐associated complication in A sian patients. Furthermore, Southeast A sia has one of the highest rates of end‐stage renal disease ( ESRD ) in the world. Consequently, CKD in diabetes is associated with considerable morbidity and cardiovascular‐related mortality, highlighting the need to screen and assess patients early in the course of the disease. The management of type 2 diabetes patients with declining renal function represents a significant challenge. Many of the older antidiabetic agents, such as metformin and sulfonylureas, are limited in their utility in CKD as a result of contraindications or hypoglycemic episodes. In contrast, dipeptidyl‐peptidase IV inhibitors have provided a welcome addition to the therapeutic armamentarium for achieving glycemic control in these special populations. With comparable efficacy to and more favorable pharmacokinetic and side‐effect profiles than traditional therapies, agents in this drug class, such as linagliptin, offer a more tailored approach to disease control in type 2 diabetes patients with declining renal function.