scholarly journals Exenatide and Renal Outcomes in Patients with Type 2 Diabetes and Diabetic Kidney Disease

2020 ◽  
Vol 51 (10) ◽  
pp. 806-814 ◽  
Author(s):  
Xiangyu Wang ◽  
Huijie Zhang ◽  
Qian Zhang ◽  
Meiping Guan ◽  
Shuyue Sheng ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Disease ◽  
Insulin Glargine ◽  
Diabetic Kidney Disease ◽  
Intervention Group ◽  
Percentage Change ◽  
Control Group ◽  
Diabetic Kidney ◽  
Renal Outcomes

<b><i>Background:</i></b> Cardiovascular outcomes in clinical trials with type 2 diabetes mellitus (T2DM) patients have shown that glucagon-like peptide-1 receptor agonist can have a beneficial effect on the kidney. This trial aimed to assess the effects of exenatide on renal outcomes in patients with T2DM and diabetic kidney disease (DKD). <b><i>Methods:</i></b> We performed a randomized parallel study encompassing 4 general hospitals. T2DM patients with an estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m<sup>2</sup> and macroalbuminuria, defined as 24-h urinary albumin excretion rate (UAER) &#x3e;0.3 g/24 h were randomized 1:1 to receive exenatide twice daily plus insulin glargine (intervention group) or insulin lispro plus glargine (control group) for 24 weeks. The primary outcome was the UAER percentage change from the baseline after 24 weeks of intervention. The rates of hypoglycemia, adverse events (AEs), and change in eGFR during the follow-up were measured as safety outcomes. <b><i>Results:</i></b> Between March 2016 and April 2019, 92 patients were randomized and took at least 1 dose of the study drug. The mean age of the participants was 56 years. At baseline, the median UAER was 1,512.0 mg/24 h and mean eGFR was 70.4 mL/min/1.73 m<sup>2</sup>. After 24 weeks of treatment, the UAER percentage change was significantly lower in the intervention group than in the control group (<i>p</i> = 0.0255). Moreover, the body weight declined by 1.3 kg in the intervention group (the difference between the 2 groups was 2.7 kg, <i>p</i> = 0.0001). Compared to the control group, a lower frequency of hypoglycemia and more gastrointestinal AEs were observed in the intervention group. <b><i>Conclusion:</i></b> Exenatide plus insulin glargine treatment for 24 weeks resulted in a reduction of albuminuria in T2DM patients with DKD.

scholarly journals Exenatide and renal outcomes in patients with type 2 diabetes and diabetic kidney disease: a multi-center, randomized, parallel study

2020 ◽  
Author(s):  
Xiangyu Wang ◽  
Qian Zhang ◽  
Meiping Guan ◽  
Shuyue Sheng ◽  
Wei Mo ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Disease ◽  
Adverse Events ◽  
Insulin Glargine ◽  
Diabetic Kidney Disease ◽  
The Body ◽  
Parallel Study ◽  
Diabetic Kidney ◽  
Renal Outcomes

Abstract Background: This trial aimed to assess the effects of exenatide, a glucagon-like peptide-1 receptor agonist (GLP-1RA), on renal outcomes in patients with type 2 diabetes mellitus (T2DM) and diabetic kidney disease (DKD).Methods: We performed a randomized, parallel study conducted in 4 general hospitals. T2DM patients with an estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73m2 and macroalbuminuria, defined as 24-hour urinary albumin excretion rate (UAER) >0.3 g/24-h, were randomized 1:1 to receive exenatide twice daily plus insulin glargine or insulin lispro plus glargine for 24 weeks. The primary outcome was percentage change in UAER after 24 weeks of intervention comparing to baseline measurement. Rates of hypoglycemia, adverse events and change in eGFR during the follow up were set as safety outcomes.Results: Between March 2016 and April 2019, 92 patients were randomized and took at least one dose of study drug. The mean age of the participants was 56 years. At baseline, the median UAER was 1512.0 mg/24-h, and mean eGFR was 70.4 mL/min/1.73 m2. After 24 weeks, exenatide reduced 29.7% of the UAER (p = 0.0255). Meanwhile, the body weight declined by 1.3 kg with exenatide (difference between groups was 2.7 kg, p = 0.0001). Comparing to the control group, lower frequency of hypoglycemia as well as more gastrointestinal adverse events were in intervention group. Conclusions: Exenatide plus insulin glargine for 24 weeks resulted in significant reduction of albuminuria in T2DM patients with DKD.Trial registration: Clinicaltrials.gov, NCT02690883. Registered 20 February, 2016, https://clinicaltrials.gov/ct2/show/NCT02690883

scholarly journals Urinary Neutrophil Gelatinase-Associated Lipocalin Is Complementary to Albuminuria in Diagnosis of Early-Stage Diabetic Kidney Disease in Type 2 Diabetes

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Agnieszka Gala-Błądzińska ◽  
Paulina Dumnicka ◽  
Beata Kuśnierz-Cabala ◽  
Katarzyna Rybak ◽  
Ryszard Drożdż ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Early Stage ◽  
Control Group ◽  
Tubular Damage ◽  
Diabetic Kidney ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase

Background. Two clinical phenotypes of diabetic kidney disease (DKD) have been reported, that is, with or without increased albuminuria. The aim of study was to assess the usefulness of urinary neutrophil gelatinase-associated lipocalin (uNGAL) for the early diagnosis of DKD in the type 2 diabetes mellitus (T2DM). Methods. The study group consisted of 123 patients with T2DM (mean age 62 ± 14 years), with urine albumin/creatinine ratio (uACR) < 300 mg/g and eGFR ≥ 60 ml/min/1.73 m2. The control group included 22 nondiabetic patients with comparable age, sex, and comorbidities. uNGAL, albumin, and creatinine were measured in the first morning urine samples. uACR and uNGAL/creatinine ratios (uNCR) were calculated. Results. In the control group, maximum uNCR was 39.64 µg/g. In T2DM group, 24 patients (20%) had higher results, with the maximum value of 378.6 µg/g. Among patients with uNCR > 39.64 µg/g, 13 (54%) did not have markedly increased albuminuria. Women with T2DM had higher uNCR than men (p<0.001), without difference in uACR (p=0.09). uNCR in T2DM patients correlated significantly with HbA1c. Sex, total cholesterol, and uACR were independent predictors of uNCR above 39.64 µg/g. Conclusions. Increased uNGAL and uNCR may indicate early tubular damage, associated with dyslipidemia and worse diabetes control, especially in females with T2DM.

scholarly journals Diabetic kidney disease: update on clinical management and non-glycaemic effects of newer medications for type 2 diabetes

2021 ◽  
Vol 12 ◽  
pp. 204201882110206
Author(s):  
Áine M. de Bhailís ◽  
Shazli Azmi ◽  
Philip A. Kalra
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Major Adverse Cardiovascular Events ◽  
Diabetic Kidney ◽  
Renal Outcomes ◽  
First Choice ◽  
Treatment Of Diabetes

Type 2 diabetes is a leading cause of chronic kidney disease worldwide and continues to increase in prevalence. This in turn has significant implications for healthcare provision and the economy. In recent years there have been multiple advances in the glucose-lowering agents available for the treatment of diabetes, which not only modify the disease itself but also have important benefits in terms of the associated cardiovascular outcomes. The cardiovascular outcome trials of agents such as glucagon-like peptide-1 receptor agonists (GLP-RAs) and sodium glucose cotransporter 2 inhibitors (SGLT-2) have demonstrated significant benefits in reducing major adverse cardiovascular events, admissions for heart failure and in some cases mortality. Secondary analysis of these trials has also indicated significant renoprotective benefit. Canagliflozin and Renal Outcomes in Type 2 Diabetes Mellitus and Nephropathy (CREDENCE) a renal-specific trial, has shown major benefits with canagliflozin for renal outcomes in diabetic kidney disease, and similar trials with other SGLT-2 inhibitors are either underway or awaiting analysis. In this article we review current goals of treatment of diabetes and the implications of advancing renal impairment on choice of treatments. Areas discussed include the diagnosis of diabetic kidney disease and current treatment strategies for diabetic kidney disease ranging from lifestyle modifications to glycaemic control. This review focuses on the role of GLP-RAs and SGLT-2 inhibitors in treating those with diabetes and chronic kidney disease with some illustrative cases. It is clear that these agents should now be considered first choice in combination with metformin in those with diabetes and increased cardiovascular risk and/or reduced renal function, and in preference to other classes such as dipeptidyl peptidase-4 (DPP-4) inhibitors or sulphonylureas.

26-LB: Exenatide and Renal Outcomes in Patients with Type 2 Diabetes and Diabetic Kidney Disease: A Multicenter, Randomized, Parallel Study

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 26-LB
Author(s):  
XIANGYU WANG ◽  
QIAN ZHANG ◽  
MEIPING GUAN ◽  
SHUYUE SHENG ◽  
WEI MO ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Parallel Study ◽  
Diabetic Kidney ◽  
Renal Outcomes

scholarly journals Fetuin-A gene polymorphism and its serum level association with atherosclerotic vascular disease in type 2 diabetes patients with early diabetic kidney disease

2020 ◽  
Vol 7 (11) ◽  
pp. 4122-4131
Author(s):  
Eman Y. Morsy ◽  
Neveen L. Saad ◽  
Hesham A. Elghoneimy ◽  
Abd Alhalim G. Smeid ◽  
Azza A. Ismail
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Control Group ◽  
Atherosclerotic Vascular Disease ◽  
Fetuin A ◽  
Diabetic Kidney ◽  
Increased Risk

Background: The incidence of type 2 diabetes mellitus (T2DM) is increasing over the past years. Early identification and management of its complications, especially diabetic kidney disease (DKD), is of great importance. Multiple factors play a role in the pathogenesis of T2DM and DKD. We aimed to study Fetuin-A gene polymorphisms and Fetuin-A serum levels in T2DM patients with early DKD. Methods: The present work was conducted on 120 patients with T2DM (60 patients with microalbuminuria and 60 without albuminuria), and 30 healthy subjects (as a control group). Serum Fetuin-A levels were measured with ELISA. Fetuin-A, Thr256Ser and Thr248Met polymorphisms were determined by PCR-RFLP. Results: Patients with T2DM had a significantly higher mean serum Fetuin-A compared to controls (p < 0.001), while no difference was observed when comparing mean serum Fetuin-A in patients with microalbuminuria and patients without albuminuria (p = 0.916). Multivariate regression analysis demonstrated that carotid intima-media thickness (CIMT) and insulin resistance had positive correlations with serum Fetuin-A (p < 0.001 and p < 0.001, respectively). Ankle-brachial pressure index (ABPI) had a negative correlation with serum Fetuin-A (p=0.046), while Fetuin-A levels neither affected eGFR nor albuminuria. The distribution of the alleles of both polymorphisms showed increased frequency of TT (rs248) and GG (rs256) in patients without albuminuria compared to patients with microalbuminuria. Conclusion: Increased serum Fetuin-A is associated with insulin resistance and increased risk of atherosclerosis in patients with T2DM, but is not associated with the development of DKD. TT (rs248) and GG (rs256) polymorphisms may be associated with lower risk of DKD.

Albuminuria Is More Closely Associated with Vascular Endothelial Function than eGFR in Type 2 Diabetes with Diabetic Kidney Disease

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 443-P
Author(s):  
YOSHINORI KAKUTANI ◽  
MASANORI EMOTO ◽  
YUKO YAMAZAKI ◽  
KOKA MOTOYAMA ◽  
TOMOAKI MORIOKA ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Disease ◽  
Endothelial Function ◽  
Diabetic Kidney Disease ◽  
Vascular Endothelial ◽  
Vascular Endothelial Function ◽  
Diabetic Kidney

Progression of diabetic kidney disease and trajectory of kidney function decline in Chinese patients with Type 2 diabetes

2019 ◽  
Vol 95 (1) ◽  
pp. 178-187 ◽  
Author(s):  
Guozhi Jiang ◽  
Andrea On Yan Luk ◽  
Claudia Ha Ting Tam ◽  
Fangying Xie ◽  
Bendix Carstensen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Disease ◽  
Kidney Function ◽  
Diabetic Kidney Disease ◽  
Chinese Patients ◽  
Diabetic Kidney ◽  
Kidney Function Decline

scholarly journals Association Between Classical and Emerging Risk Factors for Diabetic Kidney Disease and Albuminuria in a Cohort of Type 2 Diabetes Mellitus Patients

2021 ◽  
Vol 18 (3) ◽  
pp. 17-25
Author(s):  
Stoiţă Marcel ◽  
Popa Amorin Remus
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Significant Positive Association ◽  
Diabetic Kidney

Abstract The presence of albuminuria in patients with type 2 diabetes mellitus is a marker of endothelial dysfunction and also one of the criteria for diagnosing diabetic kidney disease. The present study aimed to identify associations between cardiovascular risk factors and renal albumin excretion in a group of 218 patients with type 2 diabetes mellitus. HbA1c values, systolic blood pressure, diastolic blood pressure were statistically significantly higher in patients with microalbuinuria or macroalbuminuria compared to patients with normoalbuminuria (p <0.01). We identified a statistically significant positive association between uric acid values and albuminuria, respectively 25- (OH)2 vitamin D3 deficiency and microalbuminuria (p <0.01).

scholarly journals Diabetic kidney disease: Act now or pay later

2008 ◽  
Vol 11 (4) ◽  
pp. 988-991
Author(s):  
Robert C Atkins ◽  
Paul Zimmet
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Disease ◽  
International Society ◽  
Diabetic Kidney Disease ◽  
International Diabetes Federation ◽  
Diabetic Kidney ◽  
Global Pandemic

In 2003, the International Society of Nephrology and the International Diabetes Federation launched a booklet called “Diabetes in the Kidney: Time to act” [1] to highlight the global pandemic of type 2 diabetes and diabetic kidney disease. ration (PZ)

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