The American Diabetes Association (ADA) has updated its diabetes standards of care to incorporate results from the CREDENCE trial, published in the New England Journal of Medicine.
In the placebo-controlled trial, the sodium-glucose cotransporter-2 (SGLT2) inhibitor canagliflozin was associated with reduced risk for cardiovascular events and renal failure in patients with type 2 diabetes and chronic kidney disease (CKD).
Among the updates:
• Urinary albumin (e.g., spot urinary albumin-to-creatinine ratio) and estimated glomerular filtration rate (eGFR) should be assessed at least annually in all patients with type 2 diabetes.
• For patients with type 2 diabetes and diabetic kidney disease, clinicians should consider using an SGLT2 inhibitor when the eGFR is at or above 30, especially with albuminuria above 300 mg/g, to lower renal and CV risk.
• For patients with CKD at elevated risk for CV events, a glucagon-like peptide 1 receptor agonist may lower risk for albuminuria progression and/or CV events.
The update reads: “Although the adverse event profiles of these agents must be considered, the risk-benefit balance of SGLT-2 inhibitor treatment appears to be favourable for most patients with type 2 diabetes and CKD.”