HbA1c and beyond
1Steno Diabetes Center Copenhagen, Gentofte, Denmark.
Insights
The 2020 KDIGO guideline offers updated strategies for managing diabetes in chronic kidney disease (CKD). It highlights new organ-protective therapies like SGLT2 inhibitors and GLP-1 receptor agonists for improved patient outcomes.
Area of Science:
- Nephrology
- Endocrinology
- Clinical Practice Guidelines
Background:
- The 2020 KDIGO guideline addresses the complex management of patients with both diabetes and chronic kidney disease (CKD).
- This population faces high risks of adverse health outcomes.
- Recent advancements in diabetes technology and therapeutics provide new management options.
Purpose of the Study:
- To optimize clinical care for individuals with diabetes and CKD.
- To integrate novel therapeutic options with existing management strategies.
- To provide evidence-based recommendations for comprehensive patient care.
Main Methods:
- Review of high-quality evidence, focusing on recent clinical trials.
- Analysis of new developments in diabetes management since the guideline's publication.
- Emphasis on comprehensive care, glycaemic monitoring, targets, and antihyperglycaemic therapies.
Main Results:
- Emerging evidence supports organ-protective treatments beyond glucose control, including SGLT2 inhibitors and GLP-1 receptor agonists.
- These new interventions offer expanded therapeutic opportunities for patients with diabetes and CKD.
- The guideline aims to integrate these advancements into current clinical practice.
Conclusions:
- The 2020 KDIGO guideline provides a framework for managing diabetes in CKD patients using the latest evidence.
- New therapeutic classes offer significant benefits for organ protection and overall patient outcomes.
- Optimized management strategies are crucial for this high-risk population.
Abstract:
The Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on Diabetes Management in Chronic Kidney Disease from 2020 comes at an opportune time when progress in diabetes technology and therapeutics offers new options to manage the large population of patients with diabetes and chronic kidney disease (CKD) at high risk of poor health outcomes. Management of haemoglobin A1c is important in diabetes, but an enlarging base of evidence from large clinical trials has demonstrated important new treatments offering organ protection and not just glucose management, such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists. It is the ambition that the guideline can help to optimize the clinical care of people with diabetes and CKD by integrating new options with existing management strategies based on high-quality evidence. Here, the focus has been on comprehensive care of patients with diabetes and CKD, glycaemic monitoring and targets, antihyperglycaemic therapies in patients with diabetes and CKD, and new developments since the guideline was published offering new opportunities and a wider target population for the new interventions.
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