Particularidades no manejo do diabetes em pacientes nefropatas

Abstract

Diabetes is a systemic disease that can cause damage to various organs, leading to reduction in quality of life and life expectancy. Among those organs affected by diabetes, diabetic nephropathy is noteworthy, as diabetes is the major cause of terminal renal failure in our country and throughout the world. The treatment of diabetic patients with renal failure is challenging, as severe nephropathy leads to metabolic changes that increases the chance of hypoglycemia. Insulin half-life is increased in patients with nephropathy. The development of new oral hypoglycemic agents in the past few years broadened the number of potentially advantageous therapeutic drug options for those patients. On the other hand, the complexity in the individualization of treatment is increased, as it is crucial to know the contraindications, dosage adjustment needed, risk of adverse events and nephrotoxicity of each one of those drugs. In patients in dialysis, various factors can make it difficult to achieve a good glycemic control, including factors that are related to the nephropathy itself or related to the dialysis method used. Another factor that complicates the treatment of these patients is the fact that the laboratory parameters traditionally used for the evaluation of glycemic control are prone to variations caused by the renal failure, reducing their accuracy. The knowledge of those variables is crucial to appropriately individualize the complex treatment of diabetic patients with renal failure, so that the best glycemic control could be achieved with the minimum risk of hypoglycemia. (English) [ABSTRACT FROM AUTHOR]