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©The Author(s) 2023.
World J Diabetes. Apr 15, 2023; 14(4): 352-363
Published online Apr 15, 2023. doi: 10.4239/wjd.v14.i4.352
Published online Apr 15, 2023. doi: 10.4239/wjd.v14.i4.352
Insulin resistance | CV effects[44] | CKD group | ||
ASCVD | HF | |||
Metformin | Liver gluconeogenesis (increased). Peripheral tissue glucose utilizing (increased). Net glucose absorption (decreased). Insulin resistance (markedly decreased) may benefit PCOS | Potential benefit | Neutral | eGFR < 30: Lactic acidosis |
TZDs | Insulin signaling (increased). FFA (increased). Insulin resistance (markedly decreased) | Potential benefit | Increase risk | No dose adjustment required. Fluid retention |
SUs and meglitinides | Glucotoxicity (decreased). GLUT4 expression (increased). Insulin resistance, mainly by decreasing glucotoxicity (decreased) | Neutral | Neutral | Low dose initiation to prevent hypoglycemia |
Alpha-glucosidase inhibitors | Glucotoxicity (decreased). Insulin resistance, mainly by decreasing glucotoxicity (decreased) | Potential benefit | Neutral | Contraindication in CrCl < 25 (lack of data). Liver injury? |
DPP-4 inhibitors | Improved islet beta cell function. Inflammation (decreased)? Insulin resistance (decreased) | Neutral | Potential risk: Saxagliptin and alogliptin | Generally safe. They can be used in CKD group (no dose adjustment for linagliptin) |
GLP-1RAs | Oxidative stress, inflammation (decreased). GLUT4 expression (increased). Insulin signaling (increased). Body weight (decreased): Insulin resistance (markedly decreased) | Benefit | Neutral | No dose adjustment required |
SGLT2Is | Peripheral tissue glucose utilization (increased). Energy expenditure (increased). Induce M2 macrophage polarization: Insulin resistance (markedly decreased) | Benefit | Benefit | Decrease sugar lowering effect in CKD group. Do not initiate when eGFR < 20 |
- Citation: Lin WR, Liu KH, Ling TC, Wang MC, Lin WH. Role of antidiabetic agents in type 2 diabetes patients with chronic kidney disease. World J Diabetes 2023; 14(4): 352-363
- URL: https://www.wjgnet.com/1948-9358/full/v14/i4/352.htm
- DOI: https://dx.doi.org/10.4239/wjd.v14.i4.352