Type 2 diabetes mellitus (T2DM) is one of the leading causes of chronic kidney disease (CKD) worldwide and is associated with significant morbidity and mortality. Management of T2DM in CKD patients is highly challenging due to altered pharmacokinetics, multiple comorbidities, polypharmacy, and increased susceptibility to adverse drug reactions (ADRs). Anti-diabetic medications such as metformin, sulfonylureas, insulin, sodium-glucose co-transporter-2 (SGLT-2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, thiazolidinediones, and glucagon-like peptide-1 (GLP-1) receptor agonists may produce various adverse effects ranging from mild gastrointestinal disturbances to severe hypoglycemia, lactic acidosis, dehydration, and cardiovascular complications. Early identification and appropriate therapy modification are essential to improve therapeutic safety and prevent disease progression in CKD patients. Therapy modifications including dose adjustment according to renal function, discontinuation of offending agents, switching to safer alternatives, and continuous monitoring of renal and glycemic parameters play an important role in minimizing ADR-related complications. Individualized treatment strategies are necessary to optimize glycemic control while reducing medication-related risks in patients with impaired renal function.Patient counselling is another crucial component in the management of diabetic CKD patients. Effective counselling improves medication adherence, disease awareness, self-monitoring practices, lifestyle modifications, and early recognition of complications. Clinical pharmacists play a significant role in educating patients regarding medication use, dietary modifications, insulin administration, and preventive healthcare measures. In addition, Patient Information Leaflets (PILs) serve as valuable educational tools that reinforce verbal counselling and improve patient understanding and compliance. This review focuses on the adverse drug reactions associated with anti-diabetic medications in T2DM patients with CKD, therapy modifications following ADR occurrence, and the importance of patient counselling and educational interventions in improving therapeutic outcomes and quality of life.
M.* et al. (2026) studied this question.