Antihyperglykämische Therapie bei Diabetes mellitus Typ 2 und Niereninsuffizienz - Engmaschige Stoffwechselkontrolle ist nicht ganz leicht

Abstract

mellitus is one of the leading causes of chronic kidney disease in the industrialised countries. Besides consequent lifestyle management, type 2 diabetes may be treated by several oral drugs or exogenous insulin therapy. However, in diabetic patients with impaired renal function, the use of these drugs is either restricted or even impossible. The use of metformin is restricted to patients with a glomerular filtration rate > 60 ml/min/1,73 m 2 due to the increased risk of lactic acidosis. The accumulation of the sulfonylureas and their metabolites – except gliquidon – in patients with reduced glomerular filtration rate leads to an increased risk of hypoglycaemia. The thiazolidinones are primarily metabolized hepati-cally and may therefore be used in diabetic patients with impaired renal function, but their use may be restricted by an increased risk of edema in such patients. In patients with insulin therapy, both altered clearance and metabolic efficacy of exogenous insulin lead to an increased risk of hypo-glycaemia, making tight blood glucose control more difficult.