Focus on incretin-based therapies for patients with type 2 diabetes and renal insufficiency

The treatment of T2DM requires special consideration in the presence of CKD or renal impairment. Patients with CKD and T2DM are at increased risk of cardiovascular events and mortality as well as hypoglycemia (5,6,14). However, studies have demonstrated that early glycemic control may positively affect the progression of renal impairment in T2DM (8,9). Renal dosing, risk of hypoglycemia, and fuid balance must be considered when choosing an appropriate antihyperglycemic agent in the presence of renal impairment (13,14). The incretin-based therapies-with their glycemic-lowering capabilities and low risk of hypoglycemia-are attractive options for achieving glycemic control, and some agents within these classes offer an excellent potential treatment for diabetic patients with CKD (14,18). Future randomized controlled trials and long-term follow-up studies are needed to establish whether the potential for more favorable longterm outcomes with incretin-based therapies is fully realized in patients with renal impairment.