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Oral antihyperglycemic agents and renal disease: new agents, new concepts

Jean-François Yale1

  • 1Metabolic Day Centre, Royal Victoria Hospital, Montreal, Quebec, Canada. jean-francois.yale@mcgill.ca

Journal of the American Society of Nephrology : JASN
|June 7, 2005
PubMed

Insights

Intensive glucose control prevents diabetes complications but increases hypoglycemia risk. Oral agents vary in efficacy and side effects, influencing treatment choices, especially in renal failure.

Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Pharmacology

Background:

  • Intensive glucose management is crucial for preventing microvascular complications in type 1 and type 2 diabetes, as shown by the Diabetes Control and Complications Trial (DCCT) and UK Prospective Diabetes Study.
  • Stricter glucose control goals, driven by these trials, increase the risk of hypoglycemia.
  • The choice of antihyperglycemic agents is now significantly influenced by hypoglycemia risk.

Purpose of the Study:

  • To review the role of oral antihyperglycemic agents in diabetes management.
  • To compare the efficacy, side effect profiles, and costs of different oral antihyperglycemic classes.
  • To discuss the use of oral agents and insulin in patients with chronic renal failure.

Main Methods:

  • Review of findings from major diabetes trials (DCCT, UKPDS).
  • Comparison of the mechanisms of action, efficacy (glycosylated hemoglobin reduction), and side effect profiles of oral antihyperglycemic agents.
  • Analysis of agent suitability for patients with chronic renal failure.

Main Results:

  • All oral antihyperglycemic classes, except Acarbose, reduce glycosylated hemoglobin by 1.0-1.5%.
  • Significant differences exist among agents regarding mechanisms, efficacy, side effects, and cost.
  • In chronic renal failure, repaglinide, nateglinide, and thiazolidinediones (with caution) are options, alongside insulin.

Conclusions:

  • Intensive glucose control is vital but necessitates careful agent selection due to hypoglycemia risk.
  • Oral antihyperglycemic agents offer varied therapeutic options, impacting treatment decisions.
  • Insulin and specific oral agents can be safely used in patients with chronic renal failure, requiring careful consideration.

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