Role of antidiabetic agents in type 2 diabetes patients with chronic kidney disease

Insulin resistance is a condition in which the target tissues have a decreased response to insulin signaling, resulting in glucose uptake defect, and an increased blood sugar level. Pancreatic beta cells thus enhance insulin production to compensate. This situation may cause further beta cell dysfunction and failure, which can lead diabetes mellitus (DM). Insulin resistance is thus an important cause of the development of type 2 DM. Insulin resistance has also been found to have a strong relationship with cardiovascular disease and is common in chronic kidney disease (CKD) patients. The mechanisms of insulin resistance in CKD are complex and multifactorial. They include physical inactivity, inflammation and oxidative stress, metabolic acidosis, vitamin D deficiency, adipose tissue dysfunction, uremic toxins, and renin-angiotensin-aldosterone system activation. Currently, available anti-diabetic agents, such as biguanides, sulfonylureas, thiazolidinediones, alfa-glucosidase inhibitors, glucagon-like peptide-1-based agents, and sodium-glucose co-transporter-2 inhibitors, have different effects on insulin resistance. In this short review, we describe the potential mechanisms of insulin resistance in CKD patients. We also review the interaction of currently available anti-diabetic medications with insulin resistance.

Automated summary

Insulin resistance is a condition where target tissues have a diminished response to insulin, resulting in impaired glucose uptake and elevated blood sugar levels. This can lead to beta cell dysfunction and ultimately the development of type 2 diabetes mellitus. Insulin resistance is also associated with cardiovascular disease and is common in patients with chronic kidney disease. The mechanisms of insulin resistance in CKD are complex and include factors such as physical inactivity, inflammation, metabolic acidosis, and vitamin D deficiency. Various anti-diabetic medications have different effects on insulin resistance. This review discusses the potential mechanisms of insulin resistance in CKD patients and the interaction of current anti-diabetic medications with insulin resistance.