Strategies for managing diabetic patients on peritoneal dialysis.

Failure of the pancreatic beta cells to produce insulin or development of defective molecular signaling of insulin to the peripheral tissue cells (insulin resistance) induces persistent hyperglycemia and accumulation of fatty acids in the blood of patients with diabetes. Over time, those changes lead to microvascular and macrovascular damage in various target organs. In patients on peritoneal dialysis (PD), complications may accelerate with treatment using conventional glucose-containing solutions. Strategies for proper glycemic control in diabetic PD patients are therefore essential to prevent complications and to maintain a good quality of life. Dietary restrictions and weight control remain the foundation of the management approach for glycemic control. Further therapeutic actions include the stepwise addition of oral hypoglycemic agents and insulin, based on individual assessment of PD patients. Other strategies of immediate importance in reducing hyperglycemia are to use PD exchanges with new non glucose PD solutions (such as those with icodextrin or amino acids) in combination with fewer daily exchanges of low-glucose solutions. Combined, these approaches will sufficiently control hyperglycemia in diabetic PD patients. Research is in progress to develop therapeutic agents aimed at correcting various molecular defects of insulin signaling or at reducing protein kinase C activation induced by oxidative stresses in various tissue cells. Clinical experience with the use of such agents in diabetic PD patients is limited at present.