Pharmacological management of type 2 diabetes mellitus in patients with CKD

Effective and appropriate control of blood glucose can significantly reduce the risk of diabetic complications and all-cause mortality in patients with diabetes mellitus and recent years have seen a number of new anti-diabetic medications marketed. However, approximately 30% of patients with diabetes mellitus develop progressive chronic kidney disease (CKD) limiting the selection of agents that can safely be used. Whilst older agents such as metformin and the sulphonylureas remain the mainstay of initial treatment, the elimination and adverse effects profile of a number of these drugs can be a concern in patients with CKD. Additionally, use of the newer agents is often limited by a lack of long-term safety data, particularly in this patient group. Treatment guidelines for anti-diabetic therapy rarely consider safe and efficacious management of those patients with CKD.