Possibilities of using DPP4 inhibitors and SGLT2 inhibitors in patients with type 2 diabetes mellitus with impaired renal function

Authors: Vladimír Uličiansky 1;  Zbynek Schroner 2
Authors‘ workplace: Via medica, s. r. o., Košice 1;  SchronerMED, s. r. o., interná a diabetologická ambulancia, Košice 2
Published in: Forum Diab 2015; 4(3): 171-176
Category: Main Theme: Review


The incidence and prevalence of diabetes mellitus have grown significantly. Depending on age, duration of diabetes and glycaemic control, a lot of patients with type 2 diabetes will ocur a moderate or severe deterioration of renal function. Moderate renal impairment requieres consideration of dose reduction or treatment cessation for some antidiabetic drugs. All dipeptidyl peptidase inhibitors (DPP4) can be used in mild stages chronic kidney di­sease, with no need for dose adjustment. However for estimated glomerular filtration (eGF) < 50–60 ml/min/1,73 m2, a dose reduction is required for all DPP-4 inhibitors with exeption of linagliptin. Inhibitors of the renal sodium glucose cotransporter 2 (SGLT2) have been developed to reduce the plasma glucose concentration by inducing glucosuria. Dapagliflozin, canagliflozin and empagliflozin can be safety used in eGF ≥ 60 ml/min/1,73 m2. In patients with eGF < 60 ml/min/1,73 m2, the efficacy decreases and there is an increased incidence of volume/osmotic-related side effects. Dapagliflozin is not recomended in patients who have an eGF < 60/min/1,73 m2. For canagliflozin and empagliflozin, the dose is restricted in patients with an eGF 45–60 ml/min/1,73 m2. When eGF declined to < 45/min. this drugs are contraindicated.

Key words:
type 2 diabetes – DDP4 inhibitors – SGLT2 inhibitor – renal impairment


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