Glycemic Control as Primary Prevention for Diabetic Kidney Disease

Improving strategies to prevent the development and progression of CKD is a highly desirable outcome for all involved in the care of patients with diabetes. This is because CKD is a major factor contributing to morbidly and mortality in patients with diabetes. Furthermore, diabetes is the leading cause of ESRD in most developed countries. Although tight glucose control is now an established modality for preventing the development and progression of albuminuria, evidence is now accumulating to suggest that it can also ameliorate glomerular filtration rate loss and possibly progression to ESRD. These benefits of intensive glucose control appear to be most pronounced when applied to patients with the early stages of CKD. Recently, medications that belong to the sodium glucose cotransporter-type 2 inhibitor and the glucagon-like peptide-1 receptor analogue classes have been shown to reduce progression of CKD in patients with type 2 diabetes and relatively well-preserved kidney function. Here, we review the evidence from observational and interventional clinical studies that link good glucose control with the primary prevention of diabetic kidney disease with a focus on preventing early glomerular filtration rate loss.