The effect of modern hypoglycemic therapy on the course of chronic kidney disease in patients with type 2 diabetes mellitus
The article presents the literature review of the possibilities of modern antidiabetic therapy in the prevention of chronic kidney disease in patients with type 2 diabetes mellitus. The mechanisms of development and features of kidney disease in type 2 diabetes mellitus are described. The results of most recent clinical trials for studying the possibility of nephroprotection with new groups of hypoglycemic agents are reviewed: dipeptidyl peptidase-4 inhi-bitors, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors. The advantages of usage and the nephroprotective effects of agonists of glucagon-like peptide-1 receptors and sodium-glucose loop cotransporter-2 inhibitors are determined. Particular attention is paid to the nephroprotective effect of sodium-glucose loop co-transporter inhibitors as the only class of drugs that have demonstrated a reduction in the rate of decrease in glomerular filtration rate in patients with diabetes. The expediency of further study of the efficacy of the combined use of sodium-glucose cotransporter-2 inhibitors and agonists of glucagon-like peptide-1 receptors in diabetic chronic kidney disease is indicated. For a long time, approaches to the treatment of diabetic kidney disease did not differ for patients with type 1 and type 2 diabetes. The studies of recent years have shown that new hypoglycemic drugs can not only lower blood glucose levels but also have a beneficial effect on renal function. The mechanisms of nephroprotective effects have not been fully studied, but it is clear that they are beyond the scope of improved glycemic control. The possibility of the nephroprotective effect of these drugs on a glomerular filtration rate in the range of 30–15 ml/min/1.73 m2 and below remains unexplored. The effect of the combined use of glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors is also unclear: will this combination predominate over monotherapy, and, if so, to what extent?
