Department of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Domino's Farms (Lobby G, Suite 1500) 24 Frank Lloyd Wright Drive, Ann Arbor, MI, 48106, USA.
Curr Diab Rep. 2018 Aug 15;18(10):75. doi: 10.1007/s11892-018-1044-y.
Chronic diabetic nephropathy and renal dysfunction from other causes are common in hospitalized patients with diabetes. Available diabetes management guidelines aim to reduce hyperglycemia and hypoglycemia, both independent risk factors for hospital outcomes. Renal dysfunction, which increases the risk of hypoglycemia, adds a layer of complexity in diabetes management. Therefore, modified glucose goals and treatment regimens may be required.
Recent prospective and retrospective studies provide direction on safe insulin therapy for diabetes inpatients with renal compromise. Studies of newer diabetes pharmacotherapy provide data on oral agent use in the inpatient setting. Diabetes therapy should be modified with changing renal function. Glucose management in patients on peritoneal or hemodialysis is challenging. Reducing weight-based doses of insulin and use of newer insulins can reduce hypoglycemia risk. Safety and efficacy of DPP-4 inhibitors has been evaluated in the hospital and nursing home setting. Metformin, SGLT-2 inhibitors, and GLP1 receptor agonists can be used in several stages of renal dysfunction prior to and at discharge.
慢性糖尿病肾病和其他原因导致的肾功能障碍在住院糖尿病患者中较为常见。现有的糖尿病管理指南旨在降低高血糖和低血糖，这两者都是影响住院结局的独立危险因素。肾功能障碍增加了低血糖的风险，使得糖尿病管理更加复杂。因此，可能需要调整血糖目标和治疗方案。
最近的前瞻性和回顾性研究为伴有肾功能损害的住院糖尿病患者的安全胰岛素治疗提供了指导。新型糖尿病药物治疗的研究提供了关于住院患者使用口服药物的相关数据。随着肾功能的变化，糖尿病的治疗方法应进行调整。腹膜或血液透析患者的血糖管理具有挑战性。减少基于体重的胰岛素剂量和使用新型胰岛素可以降低低血糖风险。DPP-4 抑制剂在医院和疗养院环境中的安全性和疗效已得到评估。二甲双胍、SGLT-2 抑制剂和 GLP1 受体激动剂在肾功能障碍的多个阶段（包括在住院前和出院时）都可以使用。
