- The Kidney Disease: Improving Global Outcomes (KDIGO) organization has developed a clinical practice guideline for management of patients with diabetes and chronic kidney disease (CKD) and published a synopsis.
- Comprehensive care:
- Initiate angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker in patients with diabetes, hypertension, and albuminuria, titrated to the highest approved tolerated dose.
- Advise patients who use tobacco to quit.
- Glycemic monitoring and targets:
- Use HbA1c to monitor glycemic control.
- Individualize HbA1c target ranging from
- Lifestyle interventions:
- Maintain protein intake of 0.8 g/kg/day for those not on dialysis.
- Sodium intake
- Moderate-intensity physical activity for ≥150 minutes/week, or level compatible with cardiovascular and physical tolerance.
- Antihyperglycemic therapies:
- Treat patients with type 2 diabetes, CKD, and estimated glomerular filtration rate ≥30 mL/minute/1.73 m2 with metformin and sodium-glucose cotransporter-2 inhibitor (SGLT2i).
- If glycemic targets are not achieved or if unable to use metformin/SGLT2i, initiate a long-acting glucagon-like peptide-1 receptor agonist.
- Approaches to management—implement:
- Structured self-management educational program.
- Team-based, integrated care focused on risk evaluation and patient empowerment.