Efficacy and Safety of Oral Antidiabetic Drugs in People with Diabetes and Chronic Kidney Disease: A Systematic Review.

This study is a systematic review assessing the efficacy and safety of oral antidiabetic drugs in managing type 2 diabetes mellitus in people with chronic kidney disease (CKD), focusing on their dosing and effects on renal function and glycemic control. A systematic search of online databases was conducted for published from  January  2023  to September  2024.  Studies  that  focused  on oral  antidiabetic  drugs  for  individuals  with  diabetes and  CKD, and  reported  outcomes  such  as  glycemic  control,  renal  function, and adverse events were included. A risk-of-bias assessment was performed to evaluate study quality. A  total  of  21  studies  that  met  the  criteria  were  included.  The evidences indicate that SGLT2 (Sodium-Glucose Cotransporter-2) inhibitors and GLP-1 (Glucagon-like peptide-1) receptor agonists provide renal protective benefits. SGLT2 inhibitors are more effective especially in early-stages of CKD. DPP-4 (Dipeptidyl peptidase 4) inhibitors are safe across various CKD stages and require minimal dose adjustments. Metformin remains a popular drug for glycemic control but should be monitored and even discontinued in advanced stages of CKD because of the risk of lactic acidosis. Sulfonylureas were related to hypoglycemia risk. Oral  antidiabetic  drugs,  especially  SGLT2  inhibitors  and  GLP-1 receptor  agonists,  are  suggested  in  managing  blood  glucose  in CKD  patients  owing  to  their  renal  and  cardiovascular  benefits. Individualized therapy is an important factor as drug safety and efficacy  are  influenced  by  CKD  stage,  comorbid  conditions,  and hypoglycemia risk. Individualized therapy helps maximize renal and cardiovascular protection while minimizing adverse outcomes. Regular monitoring of HbA1c (hemoglobin A1c), GFR (glomerular filtration rate), and albuminuria is recommended.