Management of diabetes mellitus in dialysis patients: Obstacles and challenges

Background and aims: Diabetic kidney disease (DKD) is a major health issue that is associated with an increased risk of morbidity and mortality. The treatment of DKD is challenging given changes in blood glucose homeostasis, unclear accuracy of glucose metrics, and altered kinetics of the blood glucose-lowering medications. There is uncertainty surrounding the optimal glycemic target in this population although recent epidemiologic data suggest that HbA1c ranges of 6-8%, as well as 7-9%, are associated with increased survival rates among diabetic dialysis patients. Furthermore, the treatment of diabetes in patients maintained on dialysis is challenging, and many blood glucose-lowering medications are renally metabolized and excreted hence requiring dose adjustment or avoidance in dialysis patients. Method: ology: PubMed, Google Scholar, and Medline were searched for all literature discussing the management of diabetes in dialysis patients. Results: The literature was discussed under many subheadings providing the latest evidence in the treatment of diabetes in dialysis patients. Conclusion: The management of diabetes in dialysis is very complex requiring a multi-disciplinary team involving endocrinologists and nephrologists to achieve targets and reduce morbidity and mortality. (C) 2021 Diabetes India. Published by Elsevier Ltd. All rights reserved.