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enseignants",{"title":54,"url":55},{"title":57,"url":58},{"title":186,"group":48,"menu":187},"Produit",[188,189,190,191,192,193,194],{"title":38,"url":7},{"title":65,"url":66},{"title":68,"url":69},{"title":71,"url":72},{"title":74,"url":75},{"title":15,"url":77},{"title":195,"url":10},"Tarification",{"title":197,"group":48,"menu":198},"Mentions légales",[199,200,201,202,203],{"title":197,"url":84},{"title":86,"url":87},{"title":89,"url":90},{"title":92,"url":93},{"title":95,"url":96},{"title":205,"group":48,"menu":206},"Service client",[207,208,209],{"title":101,"url":102},{"title":104,"url":105},{"title":107,"url":108},{"content":211,"related":265,"meta":331,"internal":341},{"title":212,"leadIn":213,"category":214,"elements":217,"becomeAnExpert":251,"author":253,"readDuration":263,"readDurationFormatted":264},"Adjusting diabetes management for patients with renal disease","Find out how to adjust the management of diabetes for patients with renal disease.",{"id":215,"name":216},1,"Course previews",[218,229,234,239,246],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},233,{"platform":223,"name":224,"url":225,"size":226},"YouTube","Altering management in renal disease","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=0UmobKHhshY",{"width":227,"height":228},200,113,{"type":230,"data":231},"free_text",{"readDurationInSeconds":232,"text":233},8,"\u003Cp>In this video, from our Diabetes Mellitus Masterclass, we'll cover the factors you'll need to consider when managing diabetes in the context of renal impairment and describe the adjustments that may be necessary for these patients.\u003C\u002Fp>",{"type":230,"data":235},{"readDurationInSeconds":236,"title":237,"text":238},11.466666666666667,"Join our Diabetes Mellitus Masterclass course today!","\u003Cp>Learn how to manage diabetes with confidence! With our \u003Cstrong>\u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fcourse\u002Fdiabetes-mellitus-masterclass\">Diabetes Mellitus Masterclass\u003C\u002Fa>\u003C\u002Fstrong> course, you'll learn how to fine-tune your patient's treatment plans, confidently initiate, adjust, and manage insulin regimes, and screen for diabetic complications with total ease.\u003C\u002Fp>",{"type":240,"data":241},"cta",{"readDurationInSeconds":242,"text":243,"buttonText":244,"buttonUrl":245},3.466666666666667,"Become a great clinician with our video courses and workshops","Start learning for free","https:\u002F\u002Fwww.medmastery.com\u002Fuser\u002Fregister",{"type":230,"data":247},{"readDurationInSeconds":248,"title":249,"text":250},122.66666666666666,"Video Transcript","\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-cf17f9ea-7fff-1f29-e251-492b1fab1d7c\">[00:00:00] \u003C\u002Fb>Diabetes is one of the leading causes of chronic kidney disease, thus, we often have to take declining renal function into consideration when adjusting our patient’s medications. Many diabetes medications need a decrease in dose as kidney function declines, since they're renally cleared and drug levels may accumulate with declining renal function. Patients with declining renal function are also at greater risk of hypoglycemia, due to decreased insulin clearance. So, treatment targets \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-cf17f9ea-7fff-1f29-e251-492b1fab1d7c\">[00:00:30] \u003C\u002Fb>may need to be adjusted as well. Metformin is one of the mainstays of treatment for patients with type 2 diabetes and metformin is renally cleared, so as renal function declines, metformin levels can accumulate. This increase is concern for metabolic acidosis. Current recommendations are to discontinue metformin if GFR is less than 30 with a dose decrease for GFR between 30 and 45. Metformin is considered safe to use at full dose for GFR over 45, although renal function should be monitored \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-cf17f9ea-7fff-1f29-e251-492b1fab1d7c\">[00:01:00] \u003C\u002Fb>more closely, checking the creatinine every three to six months. Sulfonylureas stimulate the pancreas to release insulin. Sulfonylureas are also renally cleared, so duration of action may be prolonged with renal dysfunction. This increases the risk of hypoglycemia, particularly with glyburide, which is metabolized to an active metabolite, so duration of action is longer than the other sulfonylureas. If you do use a sulfonylurea in renal dysfunction, you should up for glipizide or glimepiride, which have a lower risk for hypoglycemia. \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-cf17f9ea-7fff-1f29-e251-492b1fab1d7c\">[00:01:30] \u003C\u002Fb>You should also consider decreasing the dose, to minimize the risk of low blood sugars. The DPP-4 inhibitors are another class of medication that are renally cleared, with the exception of linagliptin. Linagliptin is not extensively metabolized and is primarily excreted in the feces so it's safe to use in renal dysfunction. The other medications in this class do need dose adjustments as renal function declines. There is limited data regarding the use of the GLP-1 receptor agonists in renal disease, although albiglutide does not require \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-cf17f9ea-7fff-1f29-e251-492b1fab1d7c\">[00:02:00] \u003C\u002Fb>dose adjustment and is likely safe to use. Exenatide is not recommended for use in chronic kidney disease stage four or five. TZDs are not renally cleared, so theoretically it would be safe to use in renal dysfunction without any dose adjustments. However, given the side effects of the TZDs including fluid retention and osteoporosis, both of which can be significantly worse with chronic kidney disease, they should generally be avoided in patients with advanced CKD. The SGLT-2 inhibitors are not effective in patients with significant \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-cf17f9ea-7fff-1f29-e251-492b1fab1d7c\">[00:02:30] \u003C\u002Fb>chronic kidney disease. Since the mechanism of this medication depends on normal renal filtration, they're not likely to provide significant benefit with GFR less than 45 and are not recommended for patients with significant renal impairment. The safest option for most patients with advanced kidney disease is insulin. Insulin is renally cleared, so when compared to those with normal kidney function, there's a longer duration of action in chronic kidney disease. But with appropriate dose adjustments, you can avoid hypoglycemia \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-cf17f9ea-7fff-1f29-e251-492b1fab1d7c\">[00:03:00] \u003C\u002Fb>and maintain good glucose control. Overall, with changes in renal function, medications that are renally cleared such as metformin, most DPP-4 inhibitors, and some GLP-1 receptor agonists will need dose adjustments to maintain levels in the therapeutic range. Other medications such as sulfonylureas and insulin will likely need dose adjustments to decrease the risk of hypoglycemia. For patients with CKD, it's important to reevaluate their diabetes treatments as kidney disease worsens, to ensure their regimens are safe \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-cf17f9ea-7fff-1f29-e251-492b1fab1d7c\">[00:03:30]\u003C\u002Fb> and appropriate.\u003C\u002Fp>",{"courses":252,"showAwardsBelow":48},[],{"id":254,"name":255,"image":256,"profession":257,"relativeUrl":260,"specializations":261},3748,"Tracy Tylee, MD","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cefc-88e6-4632-a711-cf90c6d98c24",{"name":258,"description":259},"Endocrinologist","Tracy is an Associate Professor of Endocrinology at the University of Washington, and Program Director for the Endocrinology Fellowship Program.","\u002Fteachers\u002Ftracy-tylee-md",[262],"Endocrinology",151,"3m",[266,294,313],{"id":267,"title":268,"text":269,"image":270,"author":278,"path":287,"readDuration":288,"readDurationFormatted":289,"internal":290},1352,"Injectable cholesterol medication: using PCSK9 inhibitors","Not all patients reach their LDL targets with oral therapy. Learn when injectable cholesterol medication helps and how PCSK9 inhibitors work.",{"alt":271,"title":272,"size":273,"location":275},"Two PCSK9 inhibitor autoinjector pens—an injectable cholesterol medication—shown on a light blue background.","",{"width":274,"height":274},900,{"bucket":276,"key":277},"public-drupal-medmastery-assets-production","\u002F2026-05\u002FC121(3)_magazine image.png",{"id":279,"title":280,"relativeURL":281,"image":282,"professionLong":283,"profession":284,"weight":286},1563,"Franz Wiesbauer, MD MPH","\u002Fteachers\u002Ffranz-wiesbauer-md-mph","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef0-41ee-4005-9e4a-d8711c816401","Franz is the founder and CEO of Medmastery. He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.",{"name":285},"Internist",4,"\u002Fmagazine\u002Fpcsk9-injectable-cholesterol-medication",279,"5m",{"created":291,"updated":292,"published":293},1779483663,1779495630,1779495631,{"id":295,"title":296,"text":297,"image":298,"author":304,"path":306,"readDuration":307,"readDurationFormatted":308,"internal":309},1351,"Starting statins as first-line therapy for hyperlipidemia","Starting statins: how to choose the right agent for your patient, match statin intensity to cardiovascular risk, and monitor effectively after initiation.",{"alt":299,"title":272,"size":300,"location":302},"Healthcare provider discussing starting statins with a patient and reviewing a medication bottle",{"width":301,"height":301},660,{"bucket":276,"key":303},"\u002F2026-05\u002FC121(2)_magazine image.png",{"id":279,"title":280,"relativeURL":281,"image":282,"professionLong":283,"profession":305,"weight":286},{"name":285},"\u002Fmagazine\u002Fstarting-statins-first-line-therapy",238,"4m",{"created":310,"updated":311,"published":312},1778960150,1779196374,1778961827,{"id":314,"title":315,"text":316,"image":317,"author":323,"path":325,"readDuration":326,"readDurationFormatted":264,"internal":327},1350,"How to recognize INOCA (ANOCA) on an exercise stress test ","Angina, abnormal stress test, clean coronaries—that's INOCA (or ANOCA), and it carries real risk. Learn to recognize and report it with exercise stress ECG.",{"alt":318,"title":272,"size":319,"location":321},"Illustration of the heart's coronary vasculature showing large coronary arteries and the extensive network of smaller vessels affected in INOCA (ischemia with nonobstructive coronary arteries).",{"width":320,"height":320},1200,{"bucket":276,"key":322},"\u002F2026-05\u002FC17(1)_magazine image_0.png",{"id":279,"title":280,"relativeURL":281,"image":282,"professionLong":283,"profession":324,"weight":286},{"name":285},"\u002Fmagazine\u002Fexercise-stress-ecg-inoca",141,{"created":328,"updated":329,"published":330},1778115738,1778799792,1778118255,{"seo":332,"og":334},{"title":333,"description":213},"Adjusting diabetes management for patients with renal disease | Medmastery",{"title":333,"description":213,"image":335},{"alt":272,"title":272,"size":336,"location":339},{"width":337,"height":338},696,394,{"bucket":276,"key":340},"\u002Fmigrated-images\u002FScreen Shot 2018-11-15 at 10.58.07 am.png",{"id":342,"created":343,"updated":344,"published":343},276,1544277404,1655189586]