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Lin WR, Liu KH, Ling TC, Wang MC, Lin WH. Role of antidiabetic agents in type 2 diabetes patients with chronic kidney disease. World J Diabetes 2023; 14(4): 352-363 [PMID: 37122432 DOI: 10.4239/wjd.v14.i4.352]
World J Diabetes. Apr 15, 2023; 14(4): 352-363 Published online Apr 15, 2023. doi: 10.4239/wjd.v14.i4.352
Role of antidiabetic agents in type 2 diabetes patients with chronic kidney disease
Wei-Ren Lin, Kuan-Hung Liu, Tsai-Chieh Ling, Ming-Cheng Wang, Wei-Hung Lin
Wei-Ren Lin, Kuan-Hung Liu, Tsai-Chieh Ling, Ming-Cheng Wang, Wei-Hung Lin, Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan
Author contributions: Lin WR wrote the paper; Liu KH, Ling TC, Wang MC and Lin WH edited and revised manuscript; and all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Wei-Hung Lin, MD, PhD, Associate Professor, Doctor, Staff Physician, Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, No. 138 Sheng-Li Road, Tainan 704, Taiwan. dindonwhlin@hotmail.com
Received: November 27, 2022 Peer-review started: November 27, 2022 First decision: December 26, 2022 Revised: January 10, 2023 Accepted: April 4, 2023 Article in press: April 4, 2023 Published online: April 15, 2023 Processing time: 136 Days and 2 Hours
Abstract
Insulin resistance is a condition in which the target tissues have a decreased response to insulin signaling, resulting in glucose uptake defect, and an increased blood sugar level. Pancreatic beta cells thus enhance insulin production to compensate. This situation may cause further beta cell dysfunction and failure, which can lead diabetes mellitus (DM). Insulin resistance is thus an important cause of the development of type 2 DM. Insulin resistance has also been found to have a strong relationship with cardiovascular disease and is common in chronic kidney disease (CKD) patients. The mechanisms of insulin resistance in CKD are complex and multifactorial. They include physical inactivity, inflammation and oxidative stress, metabolic acidosis, vitamin D deficiency, adipose tissue dysfunction, uremic toxins, and renin-angiotensin-aldosterone system activation. Currently, available anti-diabetic agents, such as biguanides, sulfonylureas, thiazolidinediones, alfa-glucosidase inhibitors, glucagon-like peptide-1-based agents, and sodium-glucose co-transporter-2 inhibitors, have different effects on insulin resistance. In this short review, we describe the potential mechanisms of insulin resistance in CKD patients. We also review the interaction of currently available anti-diabetic medications with insulin resistance.
Core Tip: Insulin resistance is the main cause of type 2 diabetes mellitus and is associated with cardiovascular events. It is also common in chronic kidney disease patients. We discuss the mechanisms of insulin resistance in such patients and the interaction of currently available anti-diabetic medications with insulin resistance.
