AACE MENA 2025-Management of Kidney Disease in Diabetes

Video Transcription

Video Summary

The lecture focused on recent advances in managing diabetes-related chronic kidney disease (CKD). Diabetes affects over 588 million people globally, with 40% developing kidney disease and 17% progressing to end-stage kidney disease. Traditional markers like hemoglobin A1c are often unreliable in CKD due to altered red blood cell dynamics, making continuous glucose monitoring (CGM) a valuable alternative for better glycemic assessment, despite limitations in dialysis patients.<br /><br />Management now includes four key therapeutic pillars. SGLT2 inhibitors have shown significant benefits in slowing CKD progression and are recommended even in advanced stages, with temporary cessation advised during acute illness. Non-steroidal mineralocorticoid receptor antagonists like finerenone offer kidney and cardiovascular protection, with emerging evidence supporting their use in both type 2 and type 1 diabetes. GLP-1 receptor agonists, such as semaglutide and dulaglutide, improve cardiovascular outcomes and also help preserve kidney function. New agents like the dual GIP-GLP-1 agonist, terzepatide, show promise.<br /><br />Combination therapy targeting multiple pathways appears most effective in preserving renal function. Ongoing trials are investigating optimal protocols, especially in type 1 diabetes and dialysis patients. The lecture emphasized individualized treatment focusing on proteinuria and kidney function over glycemic measures alone to better prevent CKD progression in diabetic patients.

Keywords

diabetes

chronic kidney disease

SGLT2 inhibitors

mineralocorticoid receptor antagonists

GLP-1 receptor agonists

continuous glucose monitoring

combination therapy