ISN-ISE Webinar: Practical aspects of the treatment of diabetic kidney disease

In patients with CKD, the decline in GFR reduces the clearance of insulin and many diabetes medications and raises the risk of hypoglycemia with insulin, sulfonylureas and glinides. GLP1 agonists have cardiovascular benefits, and SGLT2 inhibitors significantly decrease kidney and cardiovascular outcomes making them the class of choice for those with CKD. 

Targets for glycemic control should be individualized taking CKD into consideration, and glycemic control should be monitored with HbA1c, supplemented with SMBG or CGM when hypoglycemia is of concern. Multidisciplinary teamwork with collaboration between GP, endocrinologist and nephrologist is important for success.