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Napp brings you recent and clinically relevant publications in the evolving field of Type 2 diabetes recommended by an international panel of specialists.
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Dr. Patrick Holmes

General Practitioner, St. George's Medical Practice, Darlington, UK

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Dr. Juan José Gorgojo Martínez

Head of Department of Endocrinology and Nutrition, University Hospital Fundación, Alcorcon, Madrid, Spain

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Dr. Salvatore A. De Cosmo

Head of Unit of Internal Medicine and Endocrinology, Scientific Institute "Casa Sollievo della Sofferenza" San Giovanni Rotondo, Italy

Importance of early screening and diagnosis of CKD in T2DM

This paper reviews the burden of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM) and describes how clinicians can best utilise early screening and diagnosis together with renal protective therapies to improve patient outcomes.

Approximately 40% of patients with T2DM also develop CKD. T2DM patients with concomitant CKD have an increased risk of cardiovascular diseases, such as myocardial infarction, ischaemic stroke/transient ischaemic attacks and all-cause mortality. CKD is also associated with deficits in quality of life, and increased healthcare burden.

Early and consistent screening is vital in slowing the progression of CKD, as CKD is asymptomatic in early stages. CKD is diagnosed via estimation of the glomerular filtration rate (eGFR), which assesses renal function, and/or the detection of albuminuria (using spot urine albumin-to-creatinine ratio), a marker for renal damage. Screening enables early CKD diagnosis and pharmacological intervention. The American Diabetes Association (ADA) 2020 Standards of Care recommend newly diagnosed T2DM patients be screened for CKD, followed by monitoring testing of 1-2 times a year depending on renal function to guide therapy.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists have demonstrated beneficial effects on renal and cardiovascular outcomes. The ADA recommends that, independent of haemaglobin A1c (HbA1c), an SGLT2i with evidence of reducing CKD progression should be part of a CKD patient's treatment regimen, if tolerated and eGFR adequate.

This is a great review article reminding us not only of the high prevalence of CKD in people living with type 2 diabetes, but of the tools we can use now to preserve renal function. A must read for anyone treating those patients. Remember ‘protect the kidney, to save the heart’.

Dr. Holmes

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