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Use of Oral Glycemic Drugs in CKD
The use of oral glycemic drugs in patients with Chronic Kidney Disease (CKD) requires careful consideration due to altered drug metabolism and excretion associated with kidney dysfunction. Metformin, often the first-line treatment for type 2 diabetes, may be used with caution in mild to moderate CKD but is contraindicated in advanced stages due to the risk of lactic acidosis. Sulfonylureas, except for gliclazide and glimepiride, are generally avoided in CKD because of the prolonged hypoglycemia risk. DPP-4 inhibitors are safer options but may require dose adjustments based on renal function. SGLT2 inhibitors, beneficial for their cardiovascular and renal protective effects, are increasingly recommended, though some are contraindicated in severe CKD. GLP-1 receptor agonists offer a safer profile for CKD patients, with liraglutide and semaglutide being viable options. Ultimately, individualized treatment, frequent monitoring, and adjustments of oral hypoglycemic agents are crucial in managing diabetes in CKD patients.
About the Speaker
Dr. Adarsh K.S.
Consultant in Dept of Endocrinology, Manipal Hospitals,Bangalore
Adarsh K S is a distinguished Consultant in the Department of Endocrinology at Manipal Hospitals in Bangalore, with an extensive educational background comprising an MBBS, MD in Medicine, and a DM in Endocrinology from some of India's prestigious institutes.
Upcoming Case Discussions
Acne: Disorders and Treatment Approaches
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Congenital Uterine Anomalies
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Management of Postoperative Pain: Best Practices for GP’s
Effective management of postoperative pain is crucial for promoting recovery and preventing complications. General practitioners should start by assessing pain severity using appropriate scales, then tailor the treatment plan based on the patient's medical history and the type of surgery. A combination of pharmacological approaches, such as non-opioid analgesics (e.g., NSAIDs) and opioids when necessary, should be used to minimize pain while reducing the risk of addiction. Multimodal strategies, including physical therapy and non-pharmacological techniques like cold therapy or mindfulness, can further enhance pain relief. Close follow-up is essential to adjust the treatment as needed and ensure the patient's pain is well-controlled.
Diabetes and Stem Cells: What Does the Future Hold?
The future of diabetes treatment may be revolutionized by stem cell research, offering hope for a long-term cure. Scientists are developing stem cell therapies that could regenerate insulin-producing beta cells in the pancreas, potentially restoring natural insulin production in people with type 1 diabetes. Early clinical trials have shown promising results, with some patients reducing or eliminating their need for insulin injections. While challenges like immune rejection and long-term efficacy remain, continued advancements suggest stem cell therapy could significantly change diabetes management in the coming years.
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Dr. Adarsh K.S. 's Talks on Assimilate
- 30th-January-2024, TIME : 5:00PM - 6:00PM
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The use of oral glycemic drugs in patients with Chronic Kidney Disease (CKD) requires careful consideration due to altered drug metabolism and excretion associated with kidney dysfunction. Metformin, often the first-line treatment for type 2 diabetes, may be used with caution in mild to moderate CKD but is contraindicated in advanced stages due to the risk of lactic acidosis. Sulfonylureas, except for gliclazide and glimepiride, are generally avoided in CKD because of the prolonged hypoglycemia risk. DPP-4 inhibitors are safer options but may require dose adjustments based on renal function. SGLT2 inhibitors, beneficial for their cardiovascular and renal protective effects, are increasingly recommended, though some are contraindicated in severe CKD. GLP-1 receptor agonists offer a safer profile for CKD patients, with liraglutide and semaglutide being viable options. Ultimately, individualized treatment, frequent monitoring, and adjustments of oral hypoglycemic agents are crucial in managing diabetes in CKD patients.