Management of Type 2 Diabetes in People With Renal Impairment

Diabetes is a progressive disease associated with micro- and macrovascular complications. Type 2 diabetes (T2D) is the leading contributor to chronic kidney disease (CKD) worldwide, which itself is associated with an increased burden of cardiovascular disease, increased risk of hypoglycemia, and increased risk of death beyond that caused by diabetes alone. In this video series available on The Journal of Family Practice website, the authors discuss how CKD in people with T2D is defined, potential consequences of CKD in this patient population, and how those with CKD and T2D should be identified, monitored, and treated. The authors discuss the best management approaches for CKD in those with T2D, including blood pressure control, renin-angiotensin-aldosterone system blockade, use of sodium-glucose cotransporter-2 inhibitors, and glycemic control. The importance of glycemic control in the prevention and reduction of CKD progression in people with T2D is reviewed, with an emphasis on the use of antihyperglycemic agents as renal function declines. Finally, the authors discuss the use of basal insulin in this patient population, emphasizing the importance of reaching glycemic control goals while minimizing hypoglycemia. They note that, in people with T2D and reduced renal function, second-generation basal insulin analogs have demonstrated comparable efficacy to first-generation basal insulin analogs in reducing HbA1c levels—but with less hypoglycemia.