ADA Updates Recommendations for Diabetes and Chronic Kidney Disease

The American Diabetes Association has released updates to its diabetes standards of care, incorporating results from the CREDENCE trial, a placebo-controlled trial in which the sodium-glucose cotransporter-2 (SGLT2) inhibitor canagliflozin was shown to be associated with reduced risk for cardiovascular events and renal failure in adults with type 2 diabetes and chronic kidney disease.

Specifically, sections on Antihyperglycemic Therapies and Cardiovascular Outcomes, Antihyperglycemic Therapies and Heart Failure, Microvascular Complications and Foot Care, and Selection of Glucose-Lowering Medications for Patients with Chronic Kidney Disease saw edits, updates, and expansions.

The updates included:

• Urinary albumin and estimated glomerular filtration rate (eGFR) should be assessed annually in all patients with type 2 diabetes.
• Use of an SGLT2 inhibitor should be considered in patients with type 2 diabetes and diabetic kidney disease when eGFR is 30 or higher, especially when albuminuria is above 300 mg/g.
• A glucagon-like peptide 1 receptor agonist may lower risk for albuminuria progression and cardiovascular events in patients with chronic kidney disease who are at elevated risk for cardiovascular events.

“Although the adverse event profiles of these agents must be considered, the risk-benefit balance of SGLT-2 inhibitor treatment appears to be favorable for most patients with type 2 diabetes and chronic kidney disease,” they wrote.

—Michael Potts

Reference:

Living standards of medical care in diabetes. American Diabetes Association. Diabetes Care. https://care.diabetesjournals.org/living-standards#June%203. Updated: June 3, 2019. Accessed: June 5, 2019.