Hello there, my name is Dr. Peter Winocour,
I'm a consultant physician and the Clinical Director of
Services in East and North Hertfordshire in the United Kingdom.
I spent many years managing patients with diabetes
and kidney disease who have particular interests.
It is my pleasure to talk about the management of
patients with diabetes and chronic kidney disease.
I hope that you've been able to see the earlier talk on
the understanding of the link between diabetes and chronic kidney disease,
which came before this.
As I mentioned, one of the key 15 pillars of care and managing patients with
diabetes and CKD is, indeed, to manage hyperglycemia.
We have many therapies now which have a role to play in
managing hyperglycemia in patients with diabetes and chronic kidney disease,
and, indeed, we'll be discussing how some of these drugs have
very specific renal protective potential in this situation.
But it's important to first and foremost,
consider the impact of lifestyle measures and weight loss,
whether through calorie restriction or through bariatric procedures and one must
consider this in the context that so
often people with diabetes and kidney disease are obese,
which was one of the earlier pieces of data I showed you.
In terms of a range of drugs which work on the kidneys, the SGLT2 inhibitors,
we have got a specific treatment from the PPAR Gamma agonists class pioglitazone,
which has an effect on insulin sensitivity and thereby, improves glucose control.
We've got insulin, which of course is the most potent therapy to
reduce hyperglycemia with DPP4 therapies,
which act on an enzyme system to prolong incretins in the body,
which I'll come back to.
We've got direct incretin agonist therapy,
GLP-1 agonist which has a stronger effect than
DPP4 inhibitors in improving glucose-dependent
insulin secretion and suppress glucagon secretion
prandially and slow gastric emptying. We've got metformin,
which decreases the output of glucose from
the kidney and sensitizes the body's adipocytes, in particular,
to increase glucose uptake and we've got
sulfonylureas and shorter-acting prandial drugs called meglitinides,
which increase insulin secretion from
pancreatic Beta-cells and improve glucose control through these means.