Vnitr Lek 2015, 61(4):304-311

The treatment of diabetes in patients with liver and renal impairment

Martin Haluzík
III. interní klinika 1. LF UK a VFN Praha, přednosta prof. MUDr. Štěpán Svačina, DrSc., MBA

Diabetes mellitus is a progressive disease that may eventually lead to the development of chronic complications. In patients with type 2 diabetes, a simultaneous occurrence of liver or renal impairment is quite frequent. The presence of these diseases significantly increases the risk of hypoglycemia and in case of the renal impairment also the cardiovascular risk. At the same time, the options of antidiabetic treatment are markedly limited in particular in patients with more advanced impairment owing to the fact that numerous antidiabetic drugs are either metabolized or excreted by the liver or the kidney. In this paper, we focus on the treatment of diabetes in patients with renal or liver impairment including limitations of particular drugs and drug classes. We also briefly summarize the risks associated with renal or liver impairment with respect to antidiabetic treatment.

Keywords: diabetes mellitus; hypoglycemia; liver impairment; renal impairment

Received: February 16, 2015; Accepted: March 13, 2015; Published: April 1, 2015  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Haluzík M. The treatment of diabetes in patients with liver and renal impairment. Vnitr Lek. 2015;61(4):304-311.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Tamayo T, Rosenbauer J, Wild SH et al. Diabetes in Europe: An update for 2013 for the IDF Diabetes Atlas. Diabetes research and clinical practice 2013; 103(2): 206-217. Go to original source... Go to PubMed...
    2. Svačina S, Owen K. Syndrom inzulínové rezistence. Triton: Praha 2003. ISBN 80-7254-353-9.
    3. Gimeno-Orna JA, Castro-Alonso FJ, Boned-Juliani B et al. Fasting plasma glucose variability as a risk factor of retinopathy in Type 2 diabetic patients. J Diabetes Complications 2003; 17(2): 78-81. Go to original source... Go to PubMed...
    4. Pappachan JM, Sebastian J, Bino BC et al. Cardiac autonomic neuropathy in diabetes mellitus: prevalence, risk factors and utility of corrected QT interval in the ECG for its diagnosis. Postgrad Med J 2008; 84(990): 205-210. Go to original source... Go to PubMed...
    5. Feest TG, Dunn EJ, Burton CJ. Can intensive treatment alter the progress of established diabetic nephropathy to end-stage renal failure? QJM 1999; 92(5): 275-282. Go to original source... Go to PubMed...
    6. Haffner SM. Pre-diabetes, insulin resistance, inflammation and CVD risk. Diabetes Res Clin Pract 2003; 61(Suppl 1): S9-S18. Go to original source... Go to PubMed...
    7. Haffner SM, Lehto S, Ronnemaa T et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339(4): 229-234. Go to original source... Go to PubMed...
    8. Haffner SM. Insulin resistance, inflammation, and the prediabetic state. Am J Cardiol 2003; 92(4A): 18J-26J. Go to original source... Go to PubMed...
    9. Haluzik M, Rychlík I et al. Léčba diabetu u pacientů s onemocněním ledvin a jater. Mladá fronta: Praha 2012. ISBN 978-80-204-2671-0.
    10. Škrha J (ed). Diabetologie. Galén: Praha 2009. ISBN 978-80-7262-607-6.
    11. Haluzík M (ed). Praktická léčba diabetu. Mladá fronta: Praha 2009. ISBN 978-80-204-2071-8.
    12. Pelikánová T, Bartoš V (eds). Praktická diabetologie. 5th ed. Maxdorf: Praha 2011. ISBN 978-80-7345-244-5.
    13. Koro CE, Lee BH, Bowlin SJ. Antidiabetic medication use and prevalence of chronic kidney disease among patients with type 2 diabetes mellitus in the United States. Clin Ther 2009; 31(11): 2608-2617. Go to original source... Go to PubMed...
    14. Meyer C, Dostou JM, Welle SL et al. Role of human liver, kidney, and skeletal muscle in postprandial glucose homeostasis. Am J Physiol Endocrinol Metab 2002; 282(2): E419-E427. Go to original source... Go to PubMed...
    15. Meyer C, Dostou JM, Gerich JE. Role of the human kidney in glucose counterregulation. Diabetes 1999; 48(5): 943-948. Go to original source... Go to PubMed...
    16. Sakurai M, Takamura T, Ota T et al. Liver steatosis, but not fibrosis, is associated with insulin resistance in nonalcoholic fatty liver disease. J Gastroenterol 2007; 42(4): 312-317. Go to original source... Go to PubMed...
    17. Ali S. Fonseca V. Overview of metformin: special focus on metformin extended release. Expert Opin Pharmacother 2012; 13(12): 1797-1805. Go to original source... Go to PubMed...
    18. Anděl M, Škrha P, Trnka J. Metformin: na pomezí diabetologie a onkologie. Diabetologie, metabolizmus, endokrinologie, výživa 2013; 16(4): 212-217.
    19. Rosenstock J, Marx N, Kahn SE et al. Cardiovascular outcome trials in type 2 diabetes and the sulphonylurea controversy: rationale for the active-comparator CAROLINA trial. Diab Vasc Dis Res 2013; 10(4): 289-301. Go to original source... Go to PubMed...
    20. Promrat K, Lutchman G, Uwaifo GI et al. A pilot study of pioglitazone treatment for nonalcoholic steatohepatitis. Hepatology 2004; 39(1): 188-196. Go to original source... Go to PubMed...
    21. Ahren B, Schweizer A, Dejager S et al. Mechanisms of action of the dipeptidyl peptidase-4 inhibitor vildagliptin in humans. Diabetes Obes Metab 2011; 13(9): 775-783. Go to original source... Go to PubMed...
    22. Baetta R, Corsini A. Pharmacology of dipeptidyl peptidase-4 inhibitors: similarities and differences. Drugs 2011; 71(11): 1441-1467. Go to original source... Go to PubMed...
    23. Cai L, Cai Y, Lu ZJ et al. The efficacy and safety of vildagliptin in patients with type 2 diabetes: a meta-analysis of randomized clinical trials. J Clin Pharm Ther 2012; 37(4): 386-398. Go to original source... Go to PubMed...
    24. Scheen AJ. Pharmacokinetics of dipeptidylpeptidase-4 inhibitors. Diabetes Obes Metab 2010; 12(8): 648-658. Go to original source... Go to PubMed...
    25. Neumiller JJ. Pharmacology, efficacy, and safety of linagliptin for the treatment of type 2 diabetes mellitus. Ann Pharmacother 2012; 46(3): 358-367. Go to original source... Go to PubMed...
    26. Madsbad S. Exenatide and liraglutide: different approaches to develop GLP-1 receptor agonists (incretin mimetics) - preclinical and clinical results. Best Pract Res Clin Endocrinol Metab 2009; 23(4): 463-477. Go to original source... Go to PubMed...
    27. Davies MJ, Kela R, Khunti K. Liraglutide - overview of the preclinical and clinical data and its role in the treatment of type 2 diabetes. Diabetes Obes Metab 2011; 13(3): 207-220. Go to original source... Go to PubMed...
    28. Abdul-Ghani MA, DeFronzo RA. Inhibition of renal glucose reabsorption: a novel strategy for achieving glucose control in type 2 diabetes mellitus. Endocr Pract 2008; 14(6): 782-790. Go to original source... Go to PubMed...
    29. Detournay B, Simon D, Guillausseau PJ et al. Chronic kidney disease in type 2 diabetes patients in France: prevalence, influence of glycaemic control and implications for the pharmacological management of diabetes. Diabetes Metab 2012; 38(2): 102-112. Go to original source... Go to PubMed...
    30. Gerich JE. Role of the kidney in normal glucose homeostasis and in the hyperglycaemia of diabetes mellitus: therapeutic implications. Diabet Med 2010; 27(2): 136-142. Go to original source... Go to PubMed...
    31. Viollet B, Guigas B, Sanz Garcia N et al. Cellular and molecular mechanisms of metformin: an overview. Clin Sci (Lond) 2012; 122(6): 253-270. Go to original source... Go to PubMed...
    32. Owens DR, Swallow R, Dugi KA et al. Efficacy and safety of linagliptin in persons with type 2 diabetes inadequately controlled by a combination of metformin and sulphonylurea: a 24-week randomized study. Diabet Med 2011; 28(11): 1352-1361. Go to original source... Go to PubMed...
    33. Lincoff AM, Wolski K, Nicholls SJ et al. Pioglitazone and risk of cardiovascular events in patients with type 2 diabetes mellitus: a meta-analysis of randomized trials. JAMA 2007; 298(10): 1180-1188. Go to original source... Go to PubMed...
    34. Deacon CF. Dipeptidyl peptidase-4 inhibitors in the treatment of type 2 diabetes: a comparative review. Diabetes Obes Metab 2011; 13(1): 7-18. Go to original source... Go to PubMed...
    35. Aletti R, Cheng-Lai A. Linagliptin: the newest dipeptidyl peptidase-4 inhibitor for type 2 diabetes mellitus. Cardiol Rev 2012; 20(1): 45-51. Go to original source... Go to PubMed...
    36. Aaboe K, Krarup T, Madsbad S et al. GLP-1: physiological effects and potential therapeutic applications. Diabetes Obes Metab 2008; 10(11): 994-1003. Go to original source... Go to PubMed...
    37. Bakris GL, Fonseca VA, Sharma K et al. Renal sodium-glucose transport: role in diabetes mellitus and potential clinical implications. Kidney Int 2009; 75(12): 1272-1277. Go to original source... Go to PubMed...
    38. Iglesias P, Diez JJ. Insulin therapy in renal disease. Diabetes Obes Metab 2008; 10(10): 811-823. Go to original source... Go to PubMed...
    39. Papa G, Baratta R, Cali V et al. Factors that influence basal insulin requirement in type 2 diabetes. Acta Diabetol 2012; 49(5): 387-393. Go to original source... Go to PubMed...
    40. Dunn CJ, Plosker GL, Keating GM et al. Insulin glargine: an updated review of its use in the management of diabetes mellitus. Drugs 2003; 63(16): 1743-1778. Go to original source... Go to PubMed...
    41. Thomas MC. Renal effects of dapagliflozin in patients with type 2 diabetes. Ther Adv Endocrinol Metab 2014; 5(3): 53-61. Go to original source... Go to PubMed...
    42. Haluzik M, Frolik J, Rychlik I. Renal Effects of DPP-4 Inhibitors: A Focus on Microalbuminuria. Int J Endocrinol 2013; 2013: 895102. Dostupné z DOI: <http://doi:10.1155/2013/895102>. Go to original source... Go to PubMed...
    43. Cuthbertson DJ, Irwin A, Gardner CJ et al. Improved glycaemia correlates with liver fat reduction in obese, type 2 diabetes, patients given glucagon-like peptide-1 (GLP-1) receptor agonists. PloS one 2012; 7(12): e50117. Dostupné z DOI: <http://dx.doi.org/10.1371/journal.pone.0050117>. Go to original source... Go to PubMed...

    Return to the content


    Vnitřní lékařství

    Madam, Sir,
    please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
    Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

    I declare:

    1. that I have met the above instruction
    2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited

    No
    Yes

    If your statement is not true, please be aware
    that brings the risk of danger to their health or the health of others.