Which diabetes drug is best for diabetics with kidney disease?

Some blood-sugar-lowering drugs have caused kidney problems in patients with type 2 diabetes, so physicians are especially cautious when prescribing these agents to diabetics who also have chronic kidney disease (CKD).

Previous research indicates that the diabetes drugs sitagliptin and glipizide may not cause considerable kidney damage. New clinical trial results presented during the American Society of Nephrology's Annual Kidney Week compared the two drugs.

Sitagliptin and glipizide act on different targets but generate the same result - they boost the effects of insulin, which lowers blood sugar levels.

Juan Arjona Ferreira, MD, (MSD Corp.) and his colleagues conducted a 54-week study to compare the efficacy and safety of sitagliptin and glipizide in patients with type 2 diabetes and moderate or severe CKD who were not on dialysis. The researchers randomized 426 patients to receive sitagliptin or glipizide.

Among the major findings at the end of the study:

Blood glucose levels dropped to a similar extent in patients in both groups.
Patients receiving sitagliptin were less likely to experience hypoglycemia—or dangerously low blood sugar levels—than patients receiving glipizide (6.2% vs 17.0%).
Patients who took sitagliptin tended to lose a small amount of weight, while most patients who took glipizide experienced a slight weight gain.

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Study authors for "Efficacy and Safety of Sitagliptin vs. Glipizide in Patients with Type 2 Diabetes and Moderate to Severe Chronic Renal Insufficiency" (abstract LB-PO3166) include Juan Arjona Ferreira, MD, Michel Marre, MD, PhD, George Bakris, MD, and Ton Rabelink, MD, PhD.

Disclosures: Juan Arjona Ferreira is employed by and has ownership interest in Merck Sharp & Dohme, Corp. Michel Marre receives honoraria from is a scientific advisor for or has other relationships with Abbott, Eli Lilly, MSD, Novo Nordisk, Sanofi Aventis, and Servier. George Bakris has consultancy agreements with CVRx, Relapsya, Johnson & Johnson, Medtronic, Merck, Abbott, Takeda, and Reata; and receives research funding from Novartis, Forest, and Takeda. Ton Rabelink receives speaker fees from Daiichi Sankyo.

ASN Kidney Week 2011, the largest nephrology meeting of its kind, will provide a forum for 13,000 professionals to discuss the latest findings in renal research and engage in educational sessions related to advances in the care of patients with kidney and related disorders. Kidney Week 2011 will take place November 8 – November 13 at the Pennsylvania Convention Center in Philadelphia, PA.

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