A summary of a recent clinical practice guideline on the management of patients with diabetes and chronic kidney disease (CKD) was published by Annals of Internal Medicine on Nov. 9.
The guideline, developed by a Kidney Disease: Improving Global Outcomes (KDIGO) workgroup, includes 12 recommendations and 48 practice points for clinicians caring for patients with diabetes and CKD. The recommendations touch on comprehensive care, glycemic monitoring and targets, lifestyle interventions, antihyperglycemic therapies, and approaches to management.
Recommendations from KDIGO that are highlighted in the summary support:
- treatment with an angiotensin-converting enzyme inhibitor or an angiotensin II receptor blocker for patients with diabetes, hypertension, and albuminuria, titrated to the highest approved dose that is tolerated;
- individualized HbA1c level targets ranging from below 6.5% to below 8.0% in patients with diabetes and CKD not treated with dialysis; and
- metformin and sodium-glucose co-transporter-2 inhibitors as antihyperglycemic treatment of patients with type 2 diabetes, CKD, and an estimated glomerular filtration rate of 30 mL/min per 1.73 m2 or greater, or long-acting glucagon-like peptide-1 receptor agonists in those who have not achieved individualized glycemic targets or who are unable to use the other medications.