ADA updates recommendations on diabetes & CKD

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."