Post Date December, 03 2023
In recent years, due to the high incidence of type 2 diabetes, the number of diabetes patients with chronic kidney disease (CKD) in China is also soaring. When chronic kidney disease meets type 2 diabetes, how can patients achieve both hypoglycemic efficacy and renal safety?
Behind the scenes of chronic kidney disease
According to a survey covering more than 1000 type 2 diabetes patients in Shanghai urban area, the proportion of diabetes patients with chronic kidney disease (CKD1-5) in China is as high as 64%. Diabetes nephropathy is one of the most common chronic microvascular complications of type 2 diabetes and one of the most important causes of death of type 2 diabetes.
At the same time, type 2 diabetes is also an important "behind the scenes" to accelerate the development of chronic kidney disease. Data shows that the incidence rate of chronic kidney disease (CKD) in China is increasing year by year. It is estimated that the prevalence of CKD among adults has exceeded 10%, which means that every 10 people around us have one CKD patient! In recent years, due to the high incidence of type 2 diabetes, the number of diabetes patients with CKD in China is also increasing rapidly.
Research shows that the rate of progression of diabetes kidney disease to renal failure (also known as uremia) is about 14 times that of other kidney diseases. Once the disease progresses to the stage of renal failure, most patients need to rely on dialysis treatment, which not only greatly affects their survival and quality of life, but also brings a heavy economic burden to the family, often causing a family to return to poverty due to illness. In addition, both type 2 diabetes and chronic kidney disease significantly increase the risk of cardiovascular events, while the combination of the two diseases is no different from adding fuel to the fire, further exacerbating the risk of cardiovascular events. Many risk factors overlap. How to manage blood sugar well in diabetes with chronic kidney disease?
Two Suggestions for Managing Blood Glucose
Early strict control of blood glucose can significantly reduce the occurrence of diabetes nephropathy and delay its progress, which can be reversed in some patients after early active treatment.
First, early active treatment should be taken, and oral hypoglycemic drugs such as repaglinide, which have good hypoglycemic effects and high renal safety, can be used throughout the course of treatment in patients with chronic kidney disease (CKD1-5). This oral hypoglycemic drug has been recommended by consensus among Chinese experts. From the perspective of hypoglycemic efficacy, the effect of reducing glycosylated hemoglobin is equivalent to sulfonylureas and metformin. From the perspective of renal safety, less than 8% of metabolites are excreted through the kidney, without renal damage. Moreover, the metabolites have no hypoglycemic effect, and are not easy to accumulate in the body.
Second, it is not enough to have safe and effective hypoglycemic weapons. Type 2 diabetes combined with chronic kidney disease needs early comprehensive treatment. In addition to strictly controlling blood sugar and reducing proteinuria, patients also need to control blood pressure to meet the standard (<130/80mmHg), regulate lipid (LDL-C<100mg/dl), prevent anemia, and prevent platelet aggregation. "Kidney" should be taken seriously in selecting drugs to avoid using nephrotoxic drugs. Of course, improving lifestyle, quitting smoking, exercising appropriately, controlling weight, limiting protein and salt intake in the diet, and focusing on fruits, vegetables, and low-fat dairy products are also crucial parts of managing disease.
