Contrôler la glycémie chez les diabétiques atteints de maladie rénale jusqu'au stade de la dialyse

The good glycemic control in diabetic nephropathy with renal failure is necessary to limit the progression of this complication and those that are often related: cardiovascular, retinopathy, neuropathy, infection, until very advanced stages of the disease and even dialysis. Achieving this goal faces several challenges: limited use of several molecules, variability of insulin sensitivity, compliance, polypharmacy, risk of acute metabolic complications, especially hypoglycaemia, gastrointestinal intolerance, fatigue, depression, undernutrition. In addition, new molecules have not yet been sufficiently utilized in these particular clinical situations to ensure their safety. Finally, there is a lack of solid data on the advantages and disadvantages of more or less stringent objectives and the various treatment strategies available to us. This support is necessary though it remains difficult and should involve the diabetes specialist who is here in one of its important missions.