Glycemic Monitoring and Management in Advanced Chronic Kidney Disease.

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Clinical Guidelines
Authored By
Galindo RJ, Beck RW, Scioscia MF, Umpierrez GE, Tuttle KR
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Interests
Urology & Nephrology
Immunology Allergy & Inflammation
Internal/Family Medicine
Speciality
Immunology Allergy & Inflammation
Urology & Nephrology
Internal/Family Medicine
Book Detail
volume
41
ISSN
1945-7189
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ISSN
1945-7189
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true
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Additional Info
["Galindo RJ, Beck RW, Scioscia MF, Umpierrez GE, Tuttle KR","Publisher: Oxford University Press Country of Publication: United States NLM ID: 8006258 Publication Model: Print Cited Medium: Internet ISSN: 1945-7189 (Electronic) Linking ISSN: 0163769X NLM ISO Abbreviation: Endocr Rev Subsets: MEDLINE","Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review","2020-10-01","Endocrine reviews [Endocr Rev] 2020 Oct 01; Vol. 41 (5).","English","1945-7189","Diabetes Mellitus\/*blood , Glucose\/*metabolism , Glycated Hemoglobin\/*metabolism , Hyperglycemia\/*blood , Hypoglycemia\/*blood , Insulin\/*metabolism , Renal Insufficiency, Chronic\/*metabolism, Diabetes Mellitus\/diagnosis ; Humans ; Hyperglycemia\/diagnosis ; Hypoglycemia\/diagnosis ; Renal Insufficiency, Chronic\/complications","Diabetes Mellitus diagnosis, Humans, Hyperglycemia diagnosis, Hypoglycemia diagnosis, Renal Insufficiency, Chronic complications, Diabetes Mellitus blood, Glucose metabolism, Glycated Hemoglobin metabolism, Hyperglycemia blood, Hypoglycemia blood, Insulin metabolism, Renal Insufficiency, Chronic metabolism","Endocrine reviews","41"]
Description
Glucose and insulin metabolism in patients with diabetes are profoundly altered by advanced chronic kidney disease (CKD). Risk of hypoglycemia is increased by failure of kidney gluconeogenesis, impaired insulin clearance by the kidney, defective insulin degradation due to uremia, increased erythrocyte glucose uptake during hemodialysis, impaired counterregulatory hormone responses (cortisol, growth hormone), nutritional deprivation, and variability of exposure to oral antihyperglycemic agents and exogenous insulin. Patients with end-stage kidney disease frequently experience wide glycemic excursions, with common occurrences of both hypoglycemia and hyperglycemia. Assessment of glycemia by glycated hemoglobin (HbA1c) is hampered by a variety of CKD-associated conditions that can bias the measure either to the low or high range. Alternative glycemic biomarkers, such as glycated albumin or fructosamine, are not fully validated. Therefore, HbA1c remains the preferred glycemic biomarker despite its limitations. Based on observational data for associations with mortality and risks of hypoglycemia with intensive glycemic control regimens in advanced CKD, an HbA1c range of 7% to 8% appears to be the most favorable. Emerging data on the use of continuous glucose monitoring in this population suggest promise for more precise monitoring and treatment adjustments to permit fine-tuning of glycemic management in patients with diabetes and advanced CKD.<br /> (© Endocrine Society 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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