1
|
Mallappallil M, Sasidharan S, Sabu J, John S. Treatment of Type 2 Diabetes Mellitus in Advanced Chronic Kidney Disease for the Primary Care Physician. Cureus 2024; 16:e64663. [PMID: 39149651 PMCID: PMC11326530 DOI: 10.7759/cureus.64663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2024] [Indexed: 08/17/2024] Open
Abstract
Diabetes mellitus (DM) is a common cause of chronic kidney disease (CKD), leading to the need for renal replacement therapy (RRT). RRT includes hemodialysis (HD), peritoneal dialysis (PD), kidney transplantation (KT), and medical management. As CKD advances, the management of DM may change as medication clearance, effectiveness, and side effects can be altered due to decreasing renal clearance. Medications like metformin that were safe to use early in CKD may build up toxic levels of metabolites in advanced CKD. Other medications, like sodium-glucose co-transporter 2 inhibitors, which work by excreting glucose in the urine, may not be able to work effectively in advanced CKD due to fewer working nephrons. Insulin breakdown may take longer, and both formulation and dosing may need to be changed to avoid hypoglycemia. While DM control contributes to CKD progression, effective DM control continues to be important even after patients have been placed on RRT. Patients on RRT are frequently taken care of by a team of providers, including the primary care physician, both in and outside the hospital. Non-nephrologists who are involved with the care of a patient treated with RRT need to be adept at managing DM in this population. This paper aims to outline the management of type 2 DM in advanced CKD.
Collapse
Affiliation(s)
- Mary Mallappallil
- Internal Medicine and Nephrology, New York City (NYC) Health + Hospitals/Kings County Hospital Center, Brooklyn, USA
- Internal Medicine and Nephrology, State University of New York (SUNY) Downstate University of Health Sciences, Brooklyn, USA
| | - Sandeep Sasidharan
- Internal Medicine and Nephrology, State University of New York (SUNY) Downstate University of Health Sciences, Brooklyn, USA
- Internal Medicine and Nephrology, New York City (NYC) Health + Hospitals/Kings County Hospital Center, Brooklyn, USA
| | - Jacob Sabu
- Internal Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Sabu John
- Internal Medicine and Cardiology, New York City (NYC) Health + Hospitals/Kings County Hospital Center, Brooklyn, USA
- Internal Medicine and Cardiology, State University of New York (SUNY) Downstate University of Health Sciences, Brooklyn, USA
| |
Collapse
|
2
|
Wijewickrama P, Onyema M, Eid H, Phare N, Dick J, Moutzouris D, Lambie M, Vas P, Williams J, Karalliedde J. Standards of diabetes care and burden of hypoglycaemia in people with diabetes on peritoneal dialysis: Results from a real-world clinical audit. Perit Dial Int 2024; 44:216-220. [PMID: 37702352 DOI: 10.1177/08968608231195492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
There is limited data on the standards of diabetes care in people on peritoneal dialysis (PD). Our aim was to assess the standards of diabetes care and the burden of hypoglycaemia in people with diabetes on PD. We performed a retrospective study at three university hospitals from December 2021 to January 2022. Clinical data were extracted from electronic health records. Diabetes care of people on PD was compared against recommended standards for people with diabetes on haemodialysis (as there are no agreed standards for PD). The degree of hypoglycaemia awareness was assessed by validated questionnaires. A total of 65 adults (15 type 1, 49 type 2 and 1 monogenic-diabetes) with a mean age of 63 (range 29-88) years were evaluated. Of them, 92% had diabetes retinal screening with annual review. In contrast, in this high-risk group for foot disease, only 77% had annual foot reviews. The rates of diabetes specialist reviews were variable between hospitals at 63-94% and 10 (15%) had impaired hypoglycaemia awareness. Of the cohort, 32% had HbA1c within the acceptable range of 58-80 mmol/mol (7.5-8.5%), 21% had HbA1c below 58 mmol/mol (7.5%) and 21% (n = 14) reported at least one hypoglycaemic event per month. Our results indicate variation of care within and between different centres, and the need for improved diabetes care in people on PD. Further work is required to establish agreed standards/recommendations of diabetes care in this population. Our findings highlight the necessity of an integrated multidisciplinary approach to improve the standard of diabetes care for people on PD.
Collapse
Affiliation(s)
| | | | - Hatem Eid
- King's College Hospital London, UK
- Guy's & St Thomas' Hospital, London, UK
| | | | | | | | | | | | | | - Janaka Karalliedde
- King's College Hospital London, UK
- Guy's & St Thomas' Hospital, London, UK
| |
Collapse
|
3
|
Frankel AH, Wahba M, Ashworth V, Bedi R, Berrington R, Buckley M, Chandrasekharan L, Doyle F, Duval D, Game F, Hamilton S, Hussain S, James J, Jebb H, Karalliedde J, Kong MF, Kuverji A, Lambie M, Main C, Price S, Wijewickrama P, Williams J, Dhatariya K, Chowdhury TA. Management of adults with diabetes on dialysis: Summary of recommendations of the Joint British Diabetes Societies guidelines 2022. Diabet Med 2023; 40:e15027. [PMID: 36524709 DOI: 10.1111/dme.15027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Diabetes is the commonest cause of end-stage kidney disease in many parts of the world, and many people on dialysis programmes live with diabetes. Such people are vulnerable to complications from their diabetes, and their care may be fragmented due to the many specialists involved. This updated guidance from the Joint British Diabetes Societies aims to review and update the 2016 guidance, with particular emphasis on glycaemic monitoring in the light of recent advances in this area. In addition, the guidance covers clinical issues related to the management of diabetes in people on peritoneal dialysis, along with acute complications such as hypoglycaemia and ketoacidosis, and chronic complications such as foot and eye disease.
Collapse
Affiliation(s)
| | - Mona Wahba
- Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK
| | - Vicky Ashworth
- School of Health Sciences, Institute of Clinical Sciences, University of Liverpool, Liverpool, UK
| | - Rachna Bedi
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | - Fiona Doyle
- Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK
| | | | - Frances Game
- University Hospitals of Derby and Burton NHS Foundation, Derby, UK
- University of Nottingham, Nottingham, UK
| | - Susie Hamilton
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - June James
- Leicester Diabetes Centre, Leicester, UK
| | - Hannah Jebb
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | - Apexa Kuverji
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | - Sara Price
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Ketan Dhatariya
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Tahseen A Chowdhury
- Department of Diabetes and Metabolism, The Royal London Hospital, London, UK
| |
Collapse
|
4
|
Habas E, Errayes M, Habas E, Farfar KL, Alfitori G, Habas AE, Rayani A, Elzouki ANY. Fasting Ramadan in Chronic Kidney Disease (CKD), Kidney Transplant and Dialysis Patients: Review and Update. Cureus 2022; 14:e25269. [PMID: 35755525 PMCID: PMC9218841 DOI: 10.7759/cureus.25269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/12/2022] Open
Abstract
Chronic kidney disease (CKD) is a common disease in the Islamic regions. Dehydration occurs after prolonged fasting, particularly in hot and humid climates. In the Arabic months’ calendar, Ramadan is a month of maximum given deeds, where Muslims are required to fast from dawn till sunset. Depending on where you live and when the Ramadan month falls, fasting might last anywhere from 10 to 20 hours or more. In certain circumstances, such as poorly controlled diabetes and advanced CKD patients who are allowed to break their fast, the Ramadan fasting amendment is viable. Some Muslims, however, continue fasting despite these circumstances, placing themselves at risk, which is not allowed in the Islamic religion. There are no medical recommendations that specify who should and should not fast. Nonetheless, the recommendations have been extracted from several published studies. The authors searched EMBASE, PubMed, Google Scholar, and Google for publications, research, and reviews. All authors debate and analyze the related articles. Each author was assigned a part or two of the topics to read, study, and summarize before creating the final draft of their given section. Then this comprehensive review was completed after discussion sessions. In conclusion, by the Islamic religion view, fasting Ramadan is mandatory for every wise adult person. People who have chronic diseases or that may deteriorate by fasting are exempted from fasting. It seems that fasting and the associated disease hours are determinant factors to fasting or not fasting. Up to our knowledge, there are no established guidelines for CKD patients and physicians to follow; however, the International Diabetes Federation and Diabetes and Ramadan (IDF-DAR) Practical Guidelines 2021 have been issued for CKD diabetic patients and fasting.
Collapse
|
5
|
Blaine E, Tumlinson R, Colvin M, Haynes T, Whitley HP. Systematic literature review of insulin dose adjustments when initiating hemodialysis or peritoneal dialysis. Pharmacotherapy 2022; 42:177-187. [DOI: 10.1002/phar.2659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/18/2022]
Affiliation(s)
- Emily Blaine
- Auburn University Harrison School of Pharmacy Auburn Alabama USA
| | - Robin Tumlinson
- Auburn University Harrison School of Pharmacy Auburn Alabama USA
| | - Marion Colvin
- Auburn University Harrison School of Pharmacy Auburn Alabama USA
| | - Tyler Haynes
- Auburn University Harrison School of Pharmacy Auburn Alabama USA
| | - Heather P. Whitley
- Auburn University Harrison School of Pharmacy Auburn Alabama USA
- Baptist Family Medicine Baptist Health System Montgomery Alabama USA
| |
Collapse
|
6
|
Verbesserte Glukosekontrolle bei Dialysepatienten durch Closed-Loop-System. INFO DIABETOLOGIE 2021. [PMCID: PMC8668265 DOI: 10.1007/s15034-021-3766-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
7
|
Demidova TY, Titova VV. [Insulin therapy is a personalized approach to glycemic management in diabetes]. TERAPEVT ARKH 2020; 92:201-206. [PMID: 33720595 DOI: 10.26442/00403660.2020.12.200449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/07/2021] [Indexed: 11/22/2022]
Abstract
Type 2 diabetes is characterized by chronic hyperglycemia and varying degrees of insulin resistance and insulinopenia. Achieving targeted glycemic control in diabetic patients is important to reduce the risk of late complications, and many patients with type 2 diabetes ultimately require insulin therapy to maintain adequate glycemic control. Timely administration of insulin can prevent the progression of diabetes, reduce the development of complications, and have fewer side effects. Basal insulin is the preferred option in most cases when glycemic control is not achieved. However, there is considerable therapeutic inertia in clinical practice, both with respect to initiation of insulin therapy and titration of the basal insulin dose. The longer duration of action, reduced glucose variability and a lower risk of hypoglycemia seen with the latest generation of basal insulin analogs compared to the previous generation simplify titration and may increase patient compliance.
Collapse
Affiliation(s)
- T Y Demidova
- Pirogov Russian National Research Medical University
| | - V V Titova
- Pirogov Russian National Research Medical University
| |
Collapse
|