Possibilities of using DPP4 inhibitors and SGLT2 inhibitors in patients with type 2 diabetes mellitus with impaired renal function
Authors:
Vladimír Uličiansky 1; Zbynek Schroner 2
Authors‘ workplace:
Via medica, s. r. o., Košice
1; SchronerMED, s. r. o., interná a diabetologická ambulancia, Košice
2
Published in:
Forum Diab 2015; 4(3): 171-176
Category:
Main Theme: Review
Overview
The incidence and prevalence of diabetes mellitus have grown significantly. Depending on age, duration of diabetes and glycaemic control, a lot of patients with type 2 diabetes will ocur a moderate or severe deterioration of renal function. Moderate renal impairment requieres consideration of dose reduction or treatment cessation for some antidiabetic drugs. All dipeptidyl peptidase inhibitors (DPP4) can be used in mild stages chronic kidney disease, with no need for dose adjustment. However for estimated glomerular filtration (eGF) < 50–60 ml/min/1,73 m2, a dose reduction is required for all DPP-4 inhibitors with exeption of linagliptin. Inhibitors of the renal sodium glucose cotransporter 2 (SGLT2) have been developed to reduce the plasma glucose concentration by inducing glucosuria. Dapagliflozin, canagliflozin and empagliflozin can be safety used in eGF ≥ 60 ml/min/1,73 m2. In patients with eGF < 60 ml/min/1,73 m2, the efficacy decreases and there is an increased incidence of volume/osmotic-related side effects. Dapagliflozin is not recomended in patients who have an eGF < 60/min/1,73 m2. For canagliflozin and empagliflozin, the dose is restricted in patients with an eGF 45–60 ml/min/1,73 m2. When eGF declined to < 45/min. this drugs are contraindicated.
Key words:
type 2 diabetes – DDP4 inhibitors – SGLT2 inhibitor – renal impairment
Sources
1. Tuttle K, Bakrin GL, Bilous RW et al. Diabetic Kidney Disease: A Report From an ADA Consensus Conference. Diabetes Care 2014; 37(10): 2864–2883.
2. Okša A, Ponťuch P, Spustová V et al. Diabetická nefropatia: Diagnostika, prevencia a liečba. Odporúčané postupy Slovenskej nefrologickej spoločnosti a Slovenskej diabetologickej spoločnosti. Forum Diab 2013; 2(2-Suppl 1): 1–6.
3. Uličiansky V, Schroner V, Némethyová Z et al. Personalizovaná medicína v diabetológii v kontexte odporúčaní ADA/EASD 2015. Forum Diab 2015; 4(2): 102–118.
4. Haluzík M. Léčba diabetiků s chronickým onemocněním ledvin. In: Haluzík M, Rychlík I et al. Léčba diabetu u pacientů s onemocněním ledvin a jater. Mladá fronta: Praha 2012: 63–99. ISBN 978–80–204–2671–0.
5. Bailey CJ, Day C. Diabetes Therapies in Renal Impairment. Br J Diabetes Vasc Dis 2012; 12(4): 167–171.
6. KDIGO 2012. Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl 2013; 3(1): 1–163. Dostupné z WWW: <http://www.kdigo.org/clinical_practice_guidelines/pdf/CKD/KDIGO_2012_CKD_GL.pdf>.
7. Inzuchi SE, Bergenstal RM, Buse JB et al. Management of hyperglycemia in type 2 diabetes, 2015: Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2015; 38(1): 140–149.
8. American Diabetes Association Standards of Medical Care in Diabetes – 2015. Diabetes Care 2015; 38(Suppl 1): S1-S93.
9. AACE/ACE Diabetes Guidelines. American Association of Clinical Endocrinologists and American College of Endocrinology – Clinical Practice Guidelines for Developing A Diabetes Mellitus Comprehensive Care Plan – 2015. Endocr Pract 2015; 21(Suppl 1). Dostupné z www: https://www.aace.com/files/dm-guidelines-ccp.pdf.
10. Russo, E, Penno G, Del Prato S. Managing diabetic patients with moderate or severe renal impairment using DPP-4 inhibitors: focus on vildagliptin. Diabetes Metab Syndr Obes: Targets and Therapy 2013; 6: 161–170.
11. Davis TM. Dipeptidyl peptidase-4 inhibitors: pharmacokinetics, efficacy, tolerability and safety in renal impairment. Diabetes Obes Metab 2014; 16(10): 891–899.
12. Cheng D, Fei Y, Liu Y et al. Efficacy and Safety of Dipeptidyl Peptidase-4 Inhibitors in Type 2 Diabetes Mellitus Patients with Moderate to Severe Renal Impairment: A Systematic Review and Meta-Analysis. Plos One 2014; 9(10): e111543. Dostupné z DOI: <http://dx.doi.org/10.1371/journal.pone.0111543>.
13. Schroner Z, Uličiansky V. Inhibítory dipeptidyl peptidázy-4 – základná charakteristika a mechanizmus účinku. In: Schroner Z, Uličiansky V. Liečba založená na účinku inkretínov. 2nd ed. SchronerMED: Košice 2011: 41–61. ISBN 978–80–970714–7-9.
14. Chan JCN, Scott R, Ferreira JCA et al. Safety and efficacy of sitagliptin in patients with type 2 diabetes and chronic renal insufficiency. Diabetes Obes Metab 2008; 10(7): 545–555.
15. Ito M1, Abe M, Okada K et al. The dipeptidyl peptidase-4 (DPP-4) inhibitor vildagliptin improves glycemic control in type 2 diabetic patients undergoing hemodialysis. Endocr J 2011; 58(11): 979–987.
16. Lukashevich V, Schweizer A, Shao Q et al. Safety and efficacy of vildagliptin versus placebo in patients with type 2 diabetes and moderate or severe renal impairment: a prospective 24-week randomized placebo-controlled trial. Diabetes Obes Metab 2011; 13(10): 947–954.
17. Nowicki M, Rychlik I, Haller H et al. Saxagliptin improves glycaemic control and is well tolerated in patients with type 2 diabetes mellitus and renal impairment. Diabetes Obes Metab 2011; 13(6): 523–532.
18. McGill JB, Sloan L, Newman J et al. Long-term efficacy and safety of linagliptin in patients with type 2 diabetes and severe renal impairment: a 1-year, randomized, double-blind, placebo-controlled study. Diabetes Care 2013; 36(2): 237–244.
19. Sakai Y, Suzuki A, Mugihima K et al. Effects of Alogliptin in Chronic Kidney Disease Patient with Type 2 Diabetes. Intern Med 2014; 53(3): 195–203.
20. Ferreira AJC, Marre M, Barzilai N et al. Efficacy and safety of sitagliptin versus glipizide in patients with type 2 diabetes and moderate-to-severe chronic renal insufficiency. Diabetes Care 2013; 36(5): 1067–1073.
21. Kothny W, Lukashevich V., Foley JE et al. Comparison of vildagliptin and sitagliptin in patients with type 2 diabetes and severe renal impairment: a randomised clinical trial. Diabetologia 2015; 58(9): 2020–2026.
22. Bays H. Sodium Glucose Co-transporter Type 2 (SGLP2) Inhibitors: Targeting the Kidney to Improve Glycemic Control in Diabetes Mellitus. Diabetes Ther 2013; 4(2): 195–220.
23. DeFronzo RA, Davidson JA, Del Prato S. The role of the kidneys in glucose homeostasis: a new path towards normalizing glycaemia. Diabetes Obes Metab 2012; 14(1): 5–14.
24. Hasan FM, Alsahli M, Gerich JE. SGLT2 inhibitors in the treatment of type2 diabetes. Diabetes Res Clin Pract 2014; 104(3): 297–322. Dostupné z DOI: <http://dx.doi.org/10.1016/j.diabres.2014.02.014>.
25. Schroner Z, Uličiansky V. Inhibítory SGLT2 – nová cesta v liečbe diabetes mellitus 2. typu. SchronerMED: Košice 2015. ISBN 978–80–8129–040–4.
26. Abdul-Ghani MA, Norton L, DeFronzo RA. Sodium-Glucose Cotransporter-2 Inhibitors and Type 2 Diabetes. In: Umpierrez GE. Therapy for Diabetes Mellitus and Related Disorders. 6th ed. American Diabetes Association: Virginia 2014: 445–460. ISBN 978–1580405096.
27. Peters AL, Buschur EO, Buse JB et al. Euglycemic Diabetic Ketoacidosis: A Potential Complication of Treatment With Sodium–Glucose Cotransporter 2 Inhibition. Diabetes Care 2015; 38(9): 1687–1693.
28. Zinman B, Wanner Ch, Lachin JM et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015. Dostupné z WWW:
29. Kohan DE, Fioretto P, Tang W et al. Long-term study of patients with type 2 diabetes and moderate renal impairment shows that dapagliflozin reduces weight and blood pressure but does not improve glycemic control. Kidney Int 2014; 85(4): 962–971.
30. Yale JF, Bakris G, Cariou B et al. Efficacy and safety of canagliflozin over 52 weeks in patients with type 2 diabetes mellitus and chronic kidney disease. Diabetes Obes Metab 2014; 16(10): 1016–1027.
31. Barnett A, Mithal A, Manassie J et al. Efficacy and safety of empagliflozin added to existing anatidiabetes treatment in patients with type 2 diabetes and chronic kidney disease: a randomized, double-blind, placebo–controlled trial. Lancet Diabetes Endocrinol 2014; 2(5): 369–384.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Forum Diabetologicum
2015 Issue 3
Most read in this issue
- A view on the cardiorenal syndrome
- The most frequent infectious complications in diabetic patients and their treatment
- Incidence of diabetic nephropathy in a population of patients with diabetes mellitus in Slovakia: results of the NEFRITI investigation
- Early screening and treatment slow the progression of diabetic nephropathy