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Effects of Glycemic Control on Renal Complications

Researchers study antidiabetic treatments, other factors associated with control…

There are two main kidney diseases that are correlated with type 2 diabetes, which are chronic kidney disease and diabetes nephropathy. Good glycemic control can interrupt the progression of kidney diseases in type 2 diabetes patients with renal problems. Currently, the correlation between antidiabetic medications and glycemic control in this precise patient population is not well known. Previous research shows limited results on the renoprotective outcomes of one antidiabetic agent over another.

This purpose of this study is to identify antidiabetic treatments as well as other factors that are associated with glycemic control in patients with type 2 diabetes and different stages of chronic kidney disease. The trial was designed as a retrospective, cross-sectional study that included 242 type 2 diabetes patients and outpatients with renal complications. The trial was conducted from January 2009 to March 2010. HbA1c was used as the main biomarker to assess patients’ glycemic status. Patients were classified to have good (A1C <7%) or poor glycemic control (A1C ≥7%) based on the recommendations from American Diabetes Association guidelines.

The results showed that many of the patients presented with chronic kidney disease stage 4 (43.4%). Around 55.4% of patients were classified as having poor glycemic control. Insulin (57.9%) was the most commonly prescribed medication and sulfonylureas (43%) was second most prescribed medication. Of all antidiabetic treatment, sulfonylureas single therapy (P<0.001), insulin therapy (P=0.005), and mixture of biguanides with insulin (P=0.038) were found to be significantly associated with glycemic control. Other factors including duration of T2DM (P=0.004), comorbidities such as anemia (P=0.024) and retinopathy (P=0.033), concurrent medications such as erythropoietin therapy (P=0.047), α-blockers (P=0.033), and antigouts (P=0.003) were also correlated with A1C.

To conclude, there were limitations to the study, such as reviewing medical charts and small participant size. Many of the charts had illegible handwriting identification and important information was deliberately omitted. Small participant size can lead to a selection bias. Identification factors that are correlated with glycemic control is important to help in optimization of sugar control.

Practical Pearls:

  • Monotherapy Sulfonylurea, insulin therapy, and combination of biguanides and insulin were associated with significant glycemic control.
  • Other factors that are associated with glycemic control are duration of diagnosis, comorbidities, and medications such as erythropoietin therapy.
  • Monotherapy Sulfonylurea, insulin therapy, and combination of biguanides and insulin should be prescribed more in patients with type 2 diabetes and kidney complications due to effects on glycemic control.

Huri HZ, Lim LP, Lim SK. “Glycemic control and antidiabetic drugs in type 2 diabetes mellitus patients with renal complications.” Drug Des Devel Ther. 2015;9:4355-71.