New guideline released for treating patients with CKD and diabetes
Kidney Disease: Improving Global Outcomes has published a practice guideline for diabetes management in patients with chronic kidney disease.
Subjects covered in the guideline, which is the first released by Kidney Disease: Improving Global Outcomes (KDIGO) on the topic, include comprehensive care of patients with CKD and diabetes, glycemic monitoring and targets, lifestyle and antihyperglycemic interventions, approaches to self-management and optimal models of care.
“The past 5 [to]10 years have provided new hope for improved prevention and treatment of CKD among people with diabetes,” KDIGO guideline authors wrote in the executive summary. “New drugs and technologies provide improved options to control glycemia and prevent CKD and its progression when added to a healthy lifestyle and other standards of care management.”
The guideline covers treatment for patients with type 1 and with type 2 diabetes. “Pharmacologic management of glycemia is one aspect of care that differs substantially by diabetes type,” according to the executive summary. “The guideline includes evidence-based recommendations for pharmacologic antihyperglycemic treatment in (type 2 diabetes) T2D and CKD but defers pharmacologic antihyperglycemic treatment of (type 1 diabetes) T1D, based on insulin, to existing guidelines from diabetes organizations.”
The work group addressed care for patients with all severities of CKD, patients with a kidney transplant and patients treated with hemodialysis or peritoneal dialysis, according to the executive summary.
Development of the guideline was co-chaired by Ian de Boer, MD, and Peter Rossing, MD.
“This guideline sets out to emphasize patient-centeredness as its core theme,” de Boer said in a press release. “When we talk about comprehensive care for patients with diabetes and CKD, it’s not simply about the glucose or the kidney. Comprehensive care is about managing the patient’s general wellbeing, including his or her cardiovascular and kidney disease risks. It is about adopting a wide range of interventions tailored to a patient’s unique background and care preferences. Fortunately, there has been tremendous recent progress in diabetes monitoring and treatment, which makes this guideline especially timely.”
The KDIGO guideline is based upon literature searches last conducted in October 2018, supplemented with additional evidence through September 2019 and updated in February 2020. It targets a broad audience of clinicians and other allied health professionals treating diabetes and CKD while being mindful of implications for policy and reimbursement, according to the press release. “As valuable as these guideline recommendations may be, they are only effective when they are appropriately implemented,” Rossing said. “This is why we strongly encourage team-based integrated care, where physicians of different specialties who treat these patients collaborate and communicate effectively. In resource-limited settings, the involvement of other health care personnel, such as nurses, dieticians, pharmacists and health care assistants, play an even more critical role in the optimal delivery of care for these patients.”
The KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease is available here.