Type 2 diabetes is the leading cause of chronic kidney disease (CKD). The prevalence of CKD is growing in parallel with the rising number of patients with type 2 diabetes globally. At present, the optimal approach to glycaemic control in patients with type 2 diabetes and advanced CKD (categories 4 and 5) remains uncertain, as these patients were largely excluded from clinical trials of glucose‐lowering therapies. Nonetheless, clinical trial data are available for the use of incretin therapies, dipeptidyl peptidase‐4 inhibitors and glucagon‐like peptide‐1 receptor agonists, for patients with type 2 diabetes and advanced CKD. This review discusses the role of incretin therapies in the management of these patients. Because the presence of advanced CKD in patients with type 2 diabetes is associated with a markedly elevated risk of cardiovascular disease (CVD), treatment strategies must include the reduction of both CKD and CVD risks because death, particularly from cardiovascular causes, is more probable than progression to end‐stage kidney disease. The management of hyperglycaemia is essential for good diabetes care even in advanced CKD. Current evidence supports an individualized approach to glycaemic management in patients with type 2 diabetes and advanced CKD, taking account of the needs of each patient, including the presence of co‐morbidities and concomitant therapies. Although additional studies are needed to establish optimal strategies for glycaemic control in patients with type 2 diabetes and advanced CKD, treatment regimens with currently available pharmacotherapy can be individually tailored to meet the needs of this growing patient population.

中文翻译：

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使用肠促胰岛素治疗 2 型糖尿病和晚期慢性肾病患者高血糖的循证治疗。


2 型糖尿病是慢性肾脏病 (CKD) 的主要原因。随着全球 2 型糖尿病患者数量的增加，CKD 的患病率也在增加。目前，2 型糖尿病和晚期 CKD（4 类和 5 类）患者的最佳血糖控制方法仍不确定，因为这些患者基本上被排除在降糖治疗的临床试验之外。尽管如此，对于 2 型糖尿病和晚期 CKD 患者使用肠促胰岛素疗法、二肽基肽酶 4 抑制剂和胰高血糖素样肽 1 受体激动剂的临床试验数据是可用的。本综述讨论了肠促胰岛素疗法在这些患者的治疗中的作用。由于 2 型糖尿病患者存在晚期 CKD 与心血管疾病 (CVD) 风险显着升高相关，因此治疗策略必须包括降低 CKD 和 CVD 风险，因为死亡（尤其是心血管原因导致的死亡）比进展为终末期肾病。即使在晚期 CKD 中，高血糖的管理对于良好的糖尿病护理也至关重要。目前的证据支持对 2 型糖尿病和晚期 CKD 患者进行个体化血糖管理，同时考虑到每位患者的需求，包括合并症和伴随治疗的存在。尽管需要进行更多研究来确定 2 型糖尿病和晚期 CKD 患者血糖控制的最佳策略，但目前可用的药物疗法的治疗方案可以单独定制，以满足不断增长的患者群体的需求。