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Insulin withdrawal in diabetic kidney disease : What are we waiting for?

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Insulin withdrawal in diabetic kidney disease : What are we waiting for?

dc.contributor.author	Morillas Ariño, Carlos
dc.contributor.author	D'Marco, Luis
dc.contributor.author	Puchades Montesa, María Jesús
dc.contributor.author	Solá Izquierdo, Eva
dc.contributor.author	Gorriz Zambrano, Carmen
dc.contributor.author	Bermúdez, Valmore
dc.contributor.author	Górriz Teruel, Jose Luis
dc.date.accessioned	2022-06-16T14:22:07Z
dc.date.available	2022-06-16T14:22:07Z
dc.date.issued	2021
dc.identifier.citation	Morillas Ariño, Carlos D'Marco, Luis Puchades Montesa, María Jesús Solá Izquierdo, Eva Gorriz Zambrano, Carmen Bermúdez, Valmore Górriz Teruel, Jose Luis 2021 Insulin withdrawal in diabetic kidney disease : What are we waiting for? International Journal Of Environmental Research And Public Health
dc.identifier.uri	https://hdl.handle.net/10550/83193
dc.description.abstract	The prevalence of type 2 diabetes mellitus worldwide stands at nearly 9.3% and it is estimated that 20-40% of these patients will develop diabetic kidney disease (DKD). DKD is the leading cause of chronic kidney disease (CKD), and these patients often present high morbidity and mortality rates, particularly in those patients with poorly controlled risk factors. Furthermore, many are overweight or obese, due primarily to insulin compensation resulting from insulin resistance. In the last decade, treatment with sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA) have been shown to be beneficial in renal and cardiovascular targets; however, in patients with CKD, the previous guidelines recommended the use of drugs such as repaglinide or dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors), plus insulin therapy. However, new guidelines have paved the way for new treatments, such as SGLT2i or GLP1-RA in patients with CKD. Currently, the new evidence supports the use of GLP1-RA in patients with an estimated glomerular filtration rate (eGFR) of up to 15 mL/min/1.73 m2 and an SGLT2i should be started with an eGFR > 60 mL/min/1.73 m2. Regarding those patients in advanced stages of CKD, the usual approach is to switch to insulin. Thus, the add-on of GLP1-RA and/or SGLT2i to insulin therapy can reduce the dose of insulin, or even allow for its withdrawal, as well as achieve a good glycaemic control with no weight gain and reduced risk of hypoglycaemia, with the added advantage of cardiorenal benefits.
dc.language.iso	eng
dc.relation.ispartof	International Journal Of Environmental Research And Public Health, 2021
dc.subject	Diabetis
dc.subject	Cor Malalties
dc.title	Insulin withdrawal in diabetic kidney disease : What are we waiting for?
dc.type	journal article	es_ES
dc.date.updated	2022-06-16T14:22:07Z
dc.identifier.doi	10.3390/ijerph18105388
dc.identifier.idgrec	154208
dc.rights.accessRights	open access	es_ES