Alpha-glucosidase inhibitors slow the absorption of glucose following a meal. However, they have not been studied in patients with advanced kidney disease and are not recommended in this setting.
Approximately 80% of the dipeptidyl peptidase–4 inhibitor sitagliptin is cleared by the kidney; therefore, the standard dose of 100 mg daily should be reduced in patients with reduced GFRs. With an estimated GFR of ≥ 30 to < 50 mL/min/1.73 m2, the recommended dose is 50 mg once daily. For patients with an estimated GFR < 30 mL/min/1.73 m2, a dose of 25 mg once daily is advised.
In the multicenter, randomized, double-blind, placebo-controlled CREDENCE trial, which enrolled 4401 patients with diabetic nephropathy, the sodium-glucose cotransporter 2 inhibitor canagliflozin was associated with a 30% reduction in the risk of progression to end-stage kidney disease; canagliflozin also significantly decreased the chances for major cardiovascular events. Canagliflozin is not approved for use in patients with T1DM.
The injectable incretin mimetic liraglutide is not metabolized by the kidney, and no dose adjustment is necessary in patients with a decreased GFR, including in patients with ESRD; however, data in this population are limited, and the manufacturer advises using caution in initiating or increasing the dose in patients with kidney disease.
Learn more about the antidiabetic agents and diabetic nephropathy.
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Cite this: A. Brent Alper. Fast Five Quiz: Diabetic Nephropathy Management - Medscape - Apr 24, 2020.