糖尿病合并慢性肾功能不全患者血糖管理的特殊要求

Special requirements of blood glucose management in patients with diabetes mellitus complicated with chronic renal insufficiency

慢性肾脏病(CKD)[包括糖尿病肾病(DN)]患者常以不同速度逐渐进展至慢性肾功能不全(CRI),乃至终末期肾衰竭,此时糖尿病(DM)患者的血糖管理有着许多特殊要求。该文介绍了以下相关注意事项:(1)慢性肾功能不全(CRI)时糖化血红蛋白(Hb A1c)检测结果可能出现偏差,此时宜选用糖化白蛋白检测;另外,CRI患者易发生低血糖,故治疗糖尿病(DM)时Hb A1c目标值应>7%,并应个体化地进行制定。(2)为了避免低血糖发生,此时治疗宜选用短效胰岛素,从小剂量开始,在密切监测血糖变化下适时调整用量,直至血糖达标。(3)以肾脏排泄为主的降糖药,当患者有CRI时需依据肾功能受损程度,相应减少药物用量或停药,以免药物体内蓄积,造成严重副反应。

Chronic kidney disease, including diabetic nephritis, usually progresses gradually into chronic renal insufficiency, even end-stage renal failure. There are many requirements in the management of blood glucose in diabetic patients. （1） Under chronic renal insufficiency （CRI） the deviation in laboratory test results ofglycated hemoglobin （HbA, c） would take place. In this situation glycated albumin might provide more reliable information of glycemic control. In addition, considering that hypoglycemia is easy to occur in the patients with CRI, HbA1C target should be〉7% and determined by a individualized way for these patients. （2） It is the most important in this status to avoid hypoglycemia occurrence, so the foUowing suggestions should be advisable： using short-acting insulin with a small initial dose; and close monitoring of serum glucose levels and timely adjusting insulin doses on the basis of serum glucose changes until reaching target. （3） The dose of drugs, which are eliminated mainly via kidney; should be reduced according to the degree of renal function damage to avoid drug accumulation and result in side-effect.