Review
Copyright ©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
Table 1 Effects of anti-diabetic medications on insulin resistance and cardiovascular outcome with precautions for patients with chronic kidney disease

Insulin resistance
CV effects[44]
CKD group
ASCVD
HF
MetforminLiver gluconeogenesis (increased). Peripheral tissue glucose utilizing (increased). Net glucose absorption (decreased). Insulin resistance (markedly decreased) may benefit PCOSPotential benefitNeutraleGFR < 30: Lactic acidosis
TZDsInsulin signaling (increased). FFA (increased). Insulin resistance (markedly decreased)Potential benefitIncrease riskNo dose adjustment required. Fluid retention
SUs and meglitinidesGlucotoxicity (decreased). GLUT4 expression (increased). Insulin resistance, mainly by decreasing glucotoxicity (decreased)NeutralNeutralLow dose initiation to prevent hypoglycemia
Alpha-glucosidase inhibitorsGlucotoxicity (decreased). Insulin resistance, mainly by decreasing glucotoxicity (decreased)Potential benefitNeutralContraindication in CrCl < 25 (lack of data). Liver injury?
DPP-4 inhibitorsImproved islet beta cell function. Inflammation (decreased)? Insulin resistance (decreased)NeutralPotential risk: Saxagliptin and alogliptinGenerally safe. They can be used in CKD group (no dose adjustment for linagliptin)
GLP-1RAsOxidative stress, inflammation (decreased). GLUT4 expression (increased). Insulin signaling (increased). Body weight (decreased): Insulin resistance (markedly decreased)BenefitNeutralNo dose adjustment required
SGLT2IsPeripheral tissue glucose utilization (increased). Energy expenditure (increased). Induce M2 macrophage polarization: Insulin resistance (markedly decreased)BenefitBenefitDecrease sugar lowering effect in CKD group. Do not initiate when eGFR < 20