11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2023

Abstract

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Presence of Coronary Artery Disease in Adults with Newly Detected Diabetes Mellitus

“…testing for evaluation of neuropathy, and urine tests for evaluation of diabetic kidney disease 5, 6 .…”

“…For patients with DM, not only glycemic control, but also prevention of chronic complications is an important issue [4][5][6][7] . Standard care in preventing complications for type 2 DM patients included comprehensive eye examination by ophthalmologist for evaluation of diabetic retinopathy, sensation A total of 499 participants underwent CCTA in the clinical health examination.…”

Change in albuminuria as a surrogate endpoint for cardiovascular and renal outcomes in patients with diabetes

“…In clinical trials, even a 6‐month 30% reduction in albuminuria by an intervention relative to control has been identified as associated with a lower hazard for progression of CKD, with the effect being stronger for patients with higher baseline UACR levels 50 . In patients with CKD who have a UACR of ≥300 mg/g, the American Diabetes Association (ADA) recommends a reduction in UACR of ≥30% to slow kidney disease progression 51 . When obtaining sequential albuminuria measurements, day‐to‐day variability in urinary protein levels needs to be considered for a meaningful representation of change in albuminuria 13,52 …”

“…Mineralocorticoid receptor antagonists can be used in addition to angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker therapies. For patients with diabetes and CKD, the ADA recommends considering non‐steroidal mineralocorticoid receptor antagonist therapy to reduce CV risk and, in patients with albuminuria, to reduce CKD progression 51 …”

Management of the ‘wicked’ combination of heart failure and chronic kidney disease in the patient with diabetes

“…25,50,93,94 The 2022 ADA and KDIGO consensus statement recommends an ACE inhibitor or ARB for patients with T2D with hypertension and albuminuria, titrated to the maximum tolerated dose, 67 and this is supported by the 2023 ADA Standards of Care (Table 1). 50 To slow the progression of CKD in patients with T2D and CKD, the ADA recommends reducing urinary albumin of 300 mg/g or higher by 30% or more for patients with macroalbuminuria. 22,50 However, clinicians should be aware that some patients with T2D may experience ESKD in the absence of albuminuria.…”