晚期慢性肾病患者的糖尿病管理。

IF 3.2 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Tahseen A Chowdhury, Dorcas Mukuba, Mahalia Casabar, Conor Byrne, M Magdi Yaqoob
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引用次数: 0

摘要

在全球范围内,糖尿病是导致终末期肾病的最常见原因,占需要接受肾替代治疗的新病例的近 40%。对接受肾脏替代治疗的晚期肾病患者进行糖尿病管理具有挑战性,因为这类患者在评估和治疗方面有一些独特之处。由于红细胞新陈代谢改变或铁/促红细胞生成素缺乏导致红细胞寿命改变,使用糖化血红蛋白进行标准血糖评估可能对这类患者无效。因此,使用连续血糖监测仪可能有助于进行更有针对性的血糖评估和改进治疗调整。由于多种生理机制的影响,晚期肾病患者发生低血糖的风险可能更高,此外,由于缺乏经验或许可证,此类患者的治疗方案也很有限。胰岛素治疗是晚期肾病糖尿病患者治疗的基础,因为许多其他类药物都有禁忌症。应根据并发症和虚弱程度调整血糖控制目标,并对透析患者进行连续血糖监测,以确保低血糖风险较低。在接受实体器官移植的患者中,移植后糖尿病很常见,而且肾移植受者的死亡率和发病率风险更高。移植后应积极筛查和管理糖尿病。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Management of diabetes in people with advanced chronic kidney disease.

Diabetes is the commonest cause of end stage kidney disease globally, accounting for almost 40% of new cases requiring renal replacement therapy. Management of diabetes in people with advanced kidney disease on renal replacement therapy is challenging due to some unique aspects of assessment and treatment in this group of patients. Standard glycaemic assessment using glycated haemoglobin may not be valid in such patients due to altered red blood cell turnover or iron/erythropoietin deficiency, leading to changed red blood cell longevity. Therefore, use of continuous glucose monitoring may be beneficial to enable more focussed glycaemic assessment and improved adjustment of therapy. People with advanced kidney disease may be at higher risk of hypoglycaemia due to a number of physiological mechanisms, and in addition, therapeutic options are limited in such patients due to lack of experience or license. Insulin therapy is the basis of treatment of people with diabetes with advanced kidney disease due to many other drugs classes being contraindicated. Targets for glycaemic control should be adjusted according to co-morbidity and frailty, and continuous glucose monitoring should be used in people on dialysis to ensure low risk of hypoglycaemia. Post-transplant diabetes is common amongst people undergoing solid organ transplantation and confers a greater risk of mortality and morbidity in kidney transplant recipients. It should be actively screened for and managed in the post-transplant setting.

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来源期刊
Diabetic Medicine
Diabetic Medicine 医学-内分泌学与代谢
CiteScore
7.20
自引率
5.70%
发文量
229
审稿时长
3-6 weeks
期刊介绍: Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”
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