Diabetestherapie mit oralen Antidiabetika bei chronischer Niereninsuffizienz

Due to a worldwide increase of type 2 diabetes a further increase in the number of patients with chronic kidney disease (CKD) and diabetes mellitus must be assumed although the individual risk for diabetic late complications is declining in some countries. The presence of CKD increases the risk for complicated hypoglycemia. Therefore, the HbA_1c target levels must be individually adjusted depending on comorbidities and treatment safety. This is complicated by the fact that in patients with advanced CKD the HbA_1c levels are falsely low. The role of the kidneys in glucose homeostasis is manifold. The inhibition of sodium glucose transporter (SGLT2) is a new and promising mechanism of action but the use is limited to patients with no or low grade CKD. In the clinical routine the type and dosage of antidiabetic drug treatment has to be adapted to the different stages of CKD. For kidney transplant recipients it is important to know that the occurrence of new onset diabetes after transplantation (NODAT) must be assumed. The implementation of appropriate screening programs is advisable.