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Table 2 Medications used in type 2 diabetes and their role in managing diabetic kidney disease

From: New strategies to improve clinical outcomes for diabetic kidney disease

Drug class

Example(s)

Mechanism/action

Evidence of kidney protective effects

GFR range (ml/min/ 1.73m2)

Biguanides

Metformin

Reduces hepatic gluconeogenesis [38]

No

>30, lower dose if 30–45

Sulfonylureas

Glipizide

Gliclazide

Glimepiride

Glyburide

Stimulates insulin secretion [39]

No

Varies by agent; generally >30

Sodium glucose transport protein-2 inhibitors (SGLT-2i)

Canagliflozin

Dapagliflozin

Empagliflozin

Ertugliflozin

Inhibits glucose reabsorption in the kidney thereby lowering blood glucose [40]

Yes

(See Table 3, discussion)

Varies by agent; generally >20

Glucagon-like Peptide Receptor Agonist (GLP-1 RA)

Exenatide

Exenatide ER

Liraglutide

Albiglutide

Dulaglutide

Semaglutide

Induces insulin secretion, reduces glucagon release, lowers hepatic gluconeogenesis, slows gastric emptying [50]

Yes

(See Table 4, discussion)

Varies by agent; generally >15; Exenatide is contraindicated for GFR <30 or ESKD

Insulin

Degludec

Glargine

Detemir

NPH

Aspart

Lispro

Glulisine

Regular

 

No

No restriction by GFR, but doses usually must be reduced for GFR <30

Dipeptidyl peptidase-4 (DPP4) inhibitors

Sitagliptin

Alogliptin

Linagliptin

Vildagliptin

Prevent GLP-1 degradation, thereby lowering blood glucose [61]

No

Varies by agent; generally >30 except for linagliptin which can be used with lower GFR

Thiazolidinediones

Pioglitazone

Nuclear transcription regulator and insulin sensitizer [62]

No

No restriction by GFR; watch for worsened fluid retention if eGFR <30

  1. Abbreviations: GFR glomerular filtration rate, ESKD end-stage kidney disease, eGFR estimated glomerular filtration rate