[Glucose lowering drugs in case of impaired renal function].

Evidence-based guidelines describe the optimal implementation order of different classes of anti-diabetic drugs in patients with type 2 diabetes mellitus (DM2). Renal impairment affects 20-40% of the DM2 patients. Guidelines do not provide information about the applicability of individual anti-diabetic drugs in patients with DM2 and impaired renal function. Renal impairment not only affects the pharmacokinetics of anti-diabetic drugs but glucose metabolism as well. Pharmacokinetic properties, as well as clinical experience with individual anti-diabetic drugs, should be used to evaluate the applicability of anti-diabetic drugs. In patients with DM2 and a creatinine clearance ≥ 60 ml/min/1.73 m2 all anti-diabetic drugs can be used at standard doses. In patients with DM2 and a creatinine clearance < 60 ml/min/1.73 m2 certain anti-diabetic drugs are contraindicated, while others should be dose-adjusted. A limited number of anti-diabetic drugs can be dosed independent of renal function.