Fast Five Quiz: Type 2 Diabetes Management

Anne L. Peters, MD


April 27, 2022

Renal impairment can affect the clearance and metabolism of glucose-lowering medications. Sulfonylureas are metabolized by the liver and eliminated in the bile and urine. In patients with renal failure, sulfonylurea metabolites may accumulate resulting in an increased risk for hypoglycemia. Owing to the narrow therapeutic index and high risk for severe hypoglycemia, sulfonylureas should be used with extreme precaution or avoided in patients from stage III kidney disease to CKD or a GFR of < 60 mL/min/1.73m2 . Selecting alternative diabetic agents with low or no hypoglycemic risk should be considered.

Although thiazolidinediones are associated with fluid retention, they are metabolized by the liver. Thus, no dose adjustment is needed in patients with reduced renal function.

Insulin can still be used to manage blood sugar in patients with declining kidney function, although doses may need to be adjusted. Because insulin is cleared by the kidneys and peripheral metabolism is reduced in patients with CKD, patients with a GFR < 60 mL/min/1.73m2 may require less insulin.

Learn more about type 2 diabetes.


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