SpringerPlus · 2016
Phytochemical analysis, antimicrobial and antioxidant activities of Euphorbia golondrina L.C. Wheeler (Euphorbiaceae Juss.): an unexplored medicinal herb reported from Cameroon.
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Ndam Lawrence Monah, Mih Afui Mathias, Tening Aaron Suh, Fongod Augustina Genla Nwana, Temenu Nkegua Anna, Fujii Yoshiharu
Аннотация
PURPOSE: Type 2 diabetes mellitus (T2DM) is the leading global cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD). Glycemic control in older adults with T2DM and advanced CKD, particularly those on dialysis, presents a clinical challenge due to altered pharmacokinetics and an increased risk of hypoglycemia. Although insulin remains the standard treatment, non-insulin antihyperglycemic agents with potential cardiorenal benefits have emerged. However, their safety and efficacy in this high-risk population remain uncertain.
OBJECTIVE: To evaluate the comparative efficacy and safety of non-insulin antihyperglycemic agents versus insulin in older adults with T2DM and advanced CKD or ESRD on dialysis.
METHODS: A systematic review of randomized controlled trials published in the last 10 years was conducted. Included studies enrolled patients aged ≥ 65 years with T2DM and stage 4-5 CKD, with or without dialysis. Comparisons involved DPP-4 inhibitors, GLP-1 receptor agonists, and thiazolidinediones versus insulin. Outcomes included changes in HbA1c, estimated glomerular filtration rate (eGFR), proteinuria, severe adverse events, and hypoglycemia. Risk of bias was assessed using the ROB 2.0 tool. The detailed assessment for each included study is presented in Table 2.
RESULTS: Eight studies (n ≈ 1,800) were included. The main characteristics and findings of these studies are summarized in Table 1. DPP-4 inhibitors reduced HbA1c by - 0.54% to - 0.72%, with low rates of severe hypoglycemia (4-5%). Dulaglutide preserved eGFR and reduced body weight compared to insulin. No significant differences were noted in cardiovascular events or mortality.
CONCLUSION: Non-insulin agents, particularly DPP-4 inhibitors, are effective and safe in older patients with advanced CKD. Further research is needed to compare these agents with SGLT2 inhibitors and to assess long-term outcomes.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40200-026-01928-1.
OBJECTIVE: To evaluate the comparative efficacy and safety of non-insulin antihyperglycemic agents versus insulin in older adults with T2DM and advanced CKD or ESRD on dialysis.
METHODS: A systematic review of randomized controlled trials published in the last 10 years was conducted. Included studies enrolled patients aged ≥ 65 years with T2DM and stage 4-5 CKD, with or without dialysis. Comparisons involved DPP-4 inhibitors, GLP-1 receptor agonists, and thiazolidinediones versus insulin. Outcomes included changes in HbA1c, estimated glomerular filtration rate (eGFR), proteinuria, severe adverse events, and hypoglycemia. Risk of bias was assessed using the ROB 2.0 tool. The detailed assessment for each included study is presented in Table 2.
RESULTS: Eight studies (n ≈ 1,800) were included. The main characteristics and findings of these studies are summarized in Table 1. DPP-4 inhibitors reduced HbA1c by - 0.54% to - 0.72%, with low rates of severe hypoglycemia (4-5%). Dulaglutide preserved eGFR and reduced body weight compared to insulin. No significant differences were noted in cardiovascular events or mortality.
CONCLUSION: Non-insulin agents, particularly DPP-4 inhibitors, are effective and safe in older patients with advanced CKD. Further research is needed to compare these agents with SGLT2 inhibitors and to assess long-term outcomes.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40200-026-01928-1.