Pathophysiology and Management of Hypoglycemiain End-Stage Renal Disease Patients: A Review

Gianchandani, Roma; Neupane, Shristi; Iyengar, Jennifer J.; Heung, Michael

doi:10.4158/ep161471.ra

Cited by 40 publications

(42 citation statements)

References 73 publications

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“…The risk of hypoglycaemia, for example, is also increased in patients with renal impairment for a number of reasons, including reduced insulin clearance and impaired renal gluconeogenesis [8,52,53]. Hypoglycaemia in patients with renal impairment mostly occurred in patients using teneligliptin in combination with other antidiabetic agents associated with hypoglycaemia (insulin, sulfonylurea or glinide), highlighting the need for caution when prescribing teneligliptin in combination with these agents in patients with renal impairment.…”

Section: Safety In Patients With Renal Impairmentmentioning

confidence: 99%

Long-Term, Real-World Safety and Efficacy of Teneligliptin: A Post-Marketing Surveillance of More Than 10,000 Patients with Type 2 Diabetes in Japan

et al. 2019

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Introduction: Teneligliptin is a dipeptidyl peptidase 4 inhibitor that was approved for the treatment of type 2 diabetes mellitus (T2DM) in Japan in 2012. We performed a long-term postmarketing surveillance (RUBY) to obtain realworld evidence regarding the safety and efficacy of teneligliptin in Japan. Methods: This 3-year follow-up RUBY surveillance registered patients with T2DM who started treatment with teneligliptin between May 2013 and February 2015 in Japan. Collected data included demographics, treatments, adverse drug reactions (ADRs) and laboratory variables. Data were evaluated in all patients and in patients divided according to baseline renal function across categories of estimated glomerular filtration rate (G1-G5) and dialysis. Safety was assessed as the incidence of ADRs and efficacy was assessed in terms of glycaemic control, for up to 3 years. Results: Of 11,677 patients registered, 10,696 and 10,249 were evaluable for safety and efficacy analyses, respectively. The median duration of exposure was 1096 days. ADRs occurred in 412 patients (3.85%) and were serious in 117 patients (1.09%). The most frequent ADR class was gastrointestinal disorders (0.68%), which included constipation. There were no new ADRs warranting attention beyond those already described in teneligliptin's package insert. ADRs and serious ADRs in renal function subgroups occurred in 3.24-7.14% and 0.65-5.36% in G1-G5, and 4.49% and 1.92% in patients on Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.11298191.

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Section: Safety In Patients With Renal Impairmentmentioning

confidence: 99%

Long-Term, Real-World Safety and Efficacy of Teneligliptin: A Post-Marketing Surveillance of More Than 10,000 Patients with Type 2 Diabetes in Japan

et al. 2019

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“…Furthermore, the usual gluconeogenic capacity of the kidney is reduced in these diseased kidneys, hampering the ability to recover from hypoglycemia [18]. Severe hypoglycemia is markedly increased in patients with ESRD who are treated with insulin [19]. As most clinicians can attest, the life of the dialysis patient can be difficult and erratic.…”

mentioning

confidence: 99%

Glycemic Control Assessment in the Dialysis Patient: Is Glycated Albumin the Answer?

Molitch¹

2017

Am J Nephrol

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“…Approximately 11% of participants had moderate or severe renal impairment at baseline, and 80 developed renal disorders (primarily microalbuminuria) during follow-up. Severe renal impairment is associated with an increased risk of hypoglycemia [ 39 ], while any degree of renal dysfunction is an independent cardiovascular risk factor in people with type 2 diabetes [ 40 , 41 ]. The available evidence [ 40 – 42 ] indicates that DPP-4 inhibitors may be a favorable choice as a glucose-lowering therapy in patients with renal diabetic complications.…”

Section: Discussionmentioning

confidence: 99%

The Use of Saxagliptin in People with Type 2 Diabetes in France: The Diapazon Epidemiological Study

et al. 2017

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IntroductionSaxagliptin is a potent, reversible inhibitor of dipeptidyl peptidase-4 that is indicated for the treatment of type 2 diabetes. The DIAPAZON study was a multicenter observational study intended to document the effectiveness, safety and patterns of saxagliptin use in France, including the saxagliptin retention rate, over 2 years of follow-up.MethodsA geographically representative sample of 304 French physicians (general practitioners and specialist endocrinologists or diabetologists) recruited 1131 adults with type 2 diabetes into an ambispective cohort; 1033 fulfilled the inclusion criteria. All had started saxagliptin during the previous 6 months or at study inclusion, and follow-up was for 24 ± 3 months after starting saxagliptin.ResultsThe mean age of the study population when starting saxagliptin was 61 years, and the mean HbA1c level was 8.0%; 79% had an HbA1c level ≥7%. Prior to starting saxagliptin treatment, most participants (91%) were receiving treatment with oral glucose-lowering drugs alone. The most commonly prescribed regimen at starting saxagliptin (53% of participants) was a combination of saxagliptin and metformin. The overall saxagliptin retention rate at 2 years was 79%, as estimated by the Kaplan-Meier method. The most common reasons for discontinuation were inadequate glycemic control (52%) and intolerance (22%). During the course of the study, the mean HbA1c level decreased to 7.0%, and the percentage of people with HbA1c <7% increased from 21% to 49%. The mean change in body weight was −1.8 kg. A total of 294 hypoglycemic episodes were reported in 70 participants (6.8%) during the follow-up period. Of these, 143 episodes in 41 participants (4.0%) occurred when saxagliptin was used in combination with agents associated with hypoglycemia, such as insulin, sulfonylureas or glinides.ConclusionSaxagliptin is efficacious and well tolerated in a real-world practice setting, with almost 80% of participants remaining on treatment after 2 years.FundingAstraZeneca, France.

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Pathophysiology and Management of Hypoglycemiain End-Stage Renal Disease Patients: A Review

Cited by 40 publications

References 73 publications

Long-Term, Real-World Safety and Efficacy of Teneligliptin: A Post-Marketing Surveillance of More Than 10,000 Patients with Type 2 Diabetes in Japan

Long-Term, Real-World Safety and Efficacy of Teneligliptin: A Post-Marketing Surveillance of More Than 10,000 Patients with Type 2 Diabetes in Japan

Glycemic Control Assessment in the Dialysis Patient: Is Glycated Albumin the Answer?

The Use of Saxagliptin in People with Type 2 Diabetes in France: The Diapazon Epidemiological Study

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