Diabetes mellitus is the leading cause of chronic kidney disease (CKD) worldwide. It significantly contributes to illness, deaths, and the burden on healthcare systems. When type 2 diabetes mellitus and CKD occur together, they create major challenges for treatment. Changes in how drugs work in the body increase the risk of side effects and make blood sugar management more difficult. This review examines how antidiabetic medications are used in patients with diabetes and CKD. A thorough search of the literature was conducted using PubMed, Scopus, Google Scholar, and Science Direct, focusing on studies published between 2014 and 2025. We included relevant observational and cohort studies that looked at prescribing trends and drug use. The evidence shows that the use of antidiabetic drugs follows a pattern based on the stages of CKD as kidney function declines. Metformin is the first choice for early CKD, but its use decreases in later stages due to safety concerns, especially the risk of lactic acidosis. Insulin therapy becomes more common in people with moderate to severe CKD. It works well and can be adjusted in dosage; however, careful management is needed to prevent low blood sugar. Newer drugs, like sodium-glucose co-transporter-2 inhibitors and dipeptidyl peptidase-4 inhibitors, are being used more often because they have better safety records and help protect the kidneys. Despite these improvements, issues like multiple medications, economic barriers, and poor prescribing practices remain, especially in areas with fewer resources. To optimize antidiabetic treatment in CKD, it is essential to prescribe drugs rationally, follow clinical guidelines, and work as a team to improve patient outcomes and reduce drug-related problems.
Nahid Nazimuddin*1, Dr. Nithin Manohar R.2, Ms. Anjana U. J.3, Asheena A.1, D. Ajin Raj1, Sona Manzoor M.1, Dr. Prasobh G. R.4 (Sat,) studied this question.