Treatment of Type 2 Diabetes in Chronic Kidney Disease (eGFR 20–60 mL/min/1.73 m²)

When type 2 diabetes co-exists with chronic kidney disease, treatment choices extend beyond glycemic control — they must also address kidney-disease progression and cardiovascular risk simultaneously.

Clinical Scenario

This protocol applies to adults with type 2 diabetes who have confirmed chronic kidney disease, defined by an estimated glomerular filtration rate (eGFR) of 20–60 mL/min/1.73 m², or by albuminuria with an albumin-to-creatinine ratio at or above 3.0 mg/mmol (30 mg/g).

The combination of type 2 diabetes and CKD — whether confirmed through reduced eGFR or elevated albuminuria — requires a specific, evidence-based treatment approach distinct from standard glycemic management.

Treatment Approach

Management in this population centres on a two-agent combination strategy drawn from two specific drug classes. For individuals already established on one of these agents, the protocol addresses when and how to incorporate the other — and the same logic applies in the reverse direction.

The full sequencing, agent selection, and clinical criteria are in the complete protocol below.

Instant Access to Structured Evidence-Based Regimens

References

In adults with type 2 diabetes who have chronic kidney disease (CKD) (with confirmed estimated glomerular filtration rate [eGFR] 20–60 mL/min/1.73 m2 and/or albuminuria), an SGLT2 inhibitor or GLP-1 RA with demonstrated benefit in this population should be used for both glycemic management and for slowing progression of CKD and reduction in cardiovascular events (irrespective of A1C) (Fig. 9.4).

If glycemia is above goal, for individuals on SGLT2i, consider incorporating a GLP-1 RA or vice versa.

DOI: 10.2337/dc26-S009 View source ↗