Garofalo Carlo, Iazzetta Nicolangelo, Camocardi Andrea, Pacilio Mario, Iodice Carmela, Minutolo Roberto, De Nicola Luca, Conte Giuseppe
G Ital Nefrol. 2015 Sep-Oct;32(5).
Diabetes mellitus (DM) is the most important non-communicable disease after hypertension. Prevalence of type 2 DM has progressively increased over the last decades. In Italy, 11.8% of the general adult population can be identified as diabetic. The major complication of DM is diabetic nephropathy (DM-CKD), which develops in approximately one-third of diabetics. Achieving optimal glycemic control is the first therapeutic goal in the management of DM-CKD. In recent years, new antidiabetic drugs have been marketed (GLP1 analogues, DPP-4 inhibitors, SGLT-2 inhibitors) to ameliorate glycemia in patients nave or treated by means of traditional agents, such as sulfonylureas, metformin, glinides, insulin. However, use of these drugs in DM-CKD should be evaluated carefully, mainly because of the higher risk of hypoglycemia that requires dosing adjustments. Metformin still represents an adequate choice if proper dose adjustments are made on the basis of renal function. Sulfonylureas with limited renal clearance, i.e., gliquidone, glipizide and gliclazide are an alternative to metformin and more effective than repaglinide on glycemic control. Other antidiabetic agents with potential nephroprotective effects, namely DPP-4 inhibitors, incretin analogues and SGLT-2 inhibitors, may allow nephroprotective effects independent of glycemic control. Insulin remains the cornerstone of therapy when oral therapy is no longer effective.
糖尿病（DM）是继高血压之后最重要的非传染性疾病。在过去几十年中，2型糖尿病的患病率呈逐渐上升趋势。在意大利，11.8%的成年普通人群被认定为糖尿病患者。糖尿病的主要并发症是糖尿病肾病（DM-CKD），约三分之一的糖尿病患者会出现该病症。实现最佳血糖控制是糖尿病肾病管理中的首要治疗目标。近年来，新型抗糖尿病药物已上市（胰高血糖素样肽1类似物、二肽基肽酶-4抑制剂、钠-葡萄糖协同转运蛋白2抑制剂），用于改善初治或使用传统药物（如磺脲类、二甲双胍、格列奈类、胰岛素）治疗患者的血糖水平。然而，在糖尿病肾病患者中使用这些药物时应谨慎评估，主要是因为低血糖风险较高，需要调整剂量。如果根据肾功能适当调整剂量，二甲双胍仍是一个合适的选择。肾清除率有限的磺脲类药物，即格列喹酮、格列吡嗪和格列齐特，可作为二甲双胍的替代药物，且在血糖控制方面比瑞格列奈更有效。其他具有潜在肾脏保护作用的抗糖尿病药物，即二肽基肽酶-4抑制剂、肠促胰岛素类似物和钠-葡萄糖协同转运蛋白2抑制剂，可能具有独立于血糖控制的肾脏保护作用。当口服治疗不再有效时，胰岛素仍然是治疗的基石。
