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Opinion

Insulin Withdrawal in Diabetic Kidney Disease: What Are We Waiting for?

1
Endocrinology Department, Hospital Doctor Peset, 46020 Valencia, Spain
2
Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain
3
CAP Sant Pere, ABS Reus 1, 43202 Tarragona, Spain
4
Facultad de Ciencias de la Salud, Universidad Simon Bolivar, Barranquilla 080001, Colombia
*
Author to whom correspondence should be addressed.
Academic Editor: Paul B. Tchounwou
Int. J. Environ. Res. Public Health 2021, 18(10), 5388; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18105388
Received: 8 April 2021 / Revised: 9 May 2021 / Accepted: 16 May 2021 / Published: 18 May 2021
(This article belongs to the Special Issue Chronic Kidney Disease: The Global Challenge)
The prevalence of type 2 diabetes mellitus worldwide stands at nearly 9.3% and it is estimated that 20–40% of these patients will develop diabetic kidney disease (DKD). DKD is the leading cause of chronic kidney disease (CKD), and these patients often present high morbidity and mortality rates, particularly in those patients with poorly controlled risk factors. Furthermore, many are overweight or obese, due primarily to insulin compensation resulting from insulin resistance. In the last decade, treatment with sodium–glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA) have been shown to be beneficial in renal and cardiovascular targets; however, in patients with CKD, the previous guidelines recommended the use of drugs such as repaglinide or dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors), plus insulin therapy. However, new guidelines have paved the way for new treatments, such as SGLT2i or GLP1-RA in patients with CKD. Currently, the new evidence supports the use of GLP1-RA in patients with an estimated glomerular filtration rate (eGFR) of up to 15 mL/min/1.73 m2 and an SGLT2i should be started with an eGFR > 60 mL/min/1.73 m2. Regarding those patients in advanced stages of CKD, the usual approach is to switch to insulin. Thus, the add-on of GLP1-RA and/or SGLT2i to insulin therapy can reduce the dose of insulin, or even allow for its withdrawal, as well as achieve a good glycaemic control with no weight gain and reduced risk of hypoglycaemia, with the added advantage of cardiorenal benefits. View Full-Text
Keywords: diabetic kidney disease; cardiovascular disease; GLP-1RA; SGLT2i; insulin diabetic kidney disease; cardiovascular disease; GLP-1RA; SGLT2i; insulin
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MDPI and ACS Style

Morillas, C.; D’Marco, L.; Puchades, M.J.; Solá-Izquierdo, E.; Gorriz-Zambrano, C.; Bermúdez, V.; Gorriz, J.L. Insulin Withdrawal in Diabetic Kidney Disease: What Are We Waiting for? Int. J. Environ. Res. Public Health 2021, 18, 5388. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18105388

AMA Style

Morillas C, D’Marco L, Puchades MJ, Solá-Izquierdo E, Gorriz-Zambrano C, Bermúdez V, Gorriz JL. Insulin Withdrawal in Diabetic Kidney Disease: What Are We Waiting for? International Journal of Environmental Research and Public Health. 2021; 18(10):5388. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18105388

Chicago/Turabian Style

Morillas, Carlos, Luis D’Marco, María J. Puchades, Eva Solá-Izquierdo, Carmen Gorriz-Zambrano, Valmore Bermúdez, and José L. Gorriz 2021. "Insulin Withdrawal in Diabetic Kidney Disease: What Are We Waiting for?" International Journal of Environmental Research and Public Health 18, no. 10: 5388. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18105388

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