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.