Nephrology Department, Coimbra University Hospitals, Coimbra, Portugal.
J Nephrol. 2013 Jul-Aug;26(4):629-35. doi: 10.5301/jn.5000248. Epub 2013 Jun 20.
Diabetes currently accounts for approximately 45% of cases of end-stage renal failure in patients undergoing hemodialysis. Several observational studies have identified a positive correlation between measures of glycemic control and cardiovascular and microvascular benefits. Several randomized prospective studies have been conducted to quantify the impact of strict glycemic control on morbidity and mortality. These studies have consistently demonstrated an association between strict glycemic control and a reduction in microvascular events, but these results contrast with the lack of consistent results regarding macrovascular events. Treating diabetes has always been challenging. This challenge is increased in chronic kidney disease, due to changes in the pharmacokinetics and pharmacodynamics of insulin and most oral antidiabetic agents. The available pharmacotherapeutic arsenal for treating type 2 diabetes mellitus currently involves approximately 6 different pharmacological classes of oral antidiabetic agents and different modalities of insulin therapy.
目前，在接受血液透析的终末期肾衰竭患者中，糖尿病约占 45%。几项观察性研究已经确定了血糖控制措施与心血管和微血管益处之间的正相关关系。已经进行了几项随机前瞻性研究来量化严格血糖控制对发病率和死亡率的影响。这些研究一致表明，严格血糖控制与微血管事件减少之间存在关联，但这些结果与大血管事件缺乏一致结果形成对比。治疗糖尿病一直具有挑战性。在慢性肾脏病中，由于胰岛素和大多数口服抗糖尿病药物的药代动力学和药效学发生变化，这种挑战更加严峻。目前，用于治疗 2 型糖尿病的可用药物治疗武器库涉及大约 6 种不同的口服抗糖尿病药物的药理学类别和不同类型的胰岛素治疗。
