Diabetes Management in Chronic Kidney Disease: Synopsis of the KDIGO 2022 Clinical Practice Guideline Update
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DESCRIPTION: The KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease is an update of the 2020 guideline from Kidney Disease: Improving Global Outcomes (KDIGO). METHODS: The KDIGO Work Group updated the guideline, which included reviewing and grading new evidence that was identified and summarized. As in the previous guideline, the Work Group used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to appraise evidence and rate the strength of recommendations and expert judgment to develop consensus practice points. New evidence led to updating of recommendations in the chapters Comprehensive Care in Patients With Diabetes and CKD (Chapter 1) and Glucose-Lowering Therapies in Patients With T2D and CKD (Chapter 4). New evidence did not change recommendations in the chapters Glycemic Monitoring and Targets in Patients With Diabetes and CKD (Chapter 2), Lifestyle Interventions in Patients With Diabetes and CKD (Chapter 3), and Approaches to Management of Patients With Diabetes and CKD (Chapter 5). RECOMMENDATIONS: The updated guideline includes 13 recommendations and 52 practice points for clinicians caring for patients with diabetes and chronic kidney disease (CKD). A focus on preserving kidney function and maintaining well-being is recommended using a layered approach to care, starting with a foundation of lifestyle interventions, self-management, and first-line pharmacotherapy (such as sodium-glucose cotransporter-2 inhibitors) demonstrated to improve clinical outcomes. To this are added additional drugs with heart and kidney protection, such as glucagon-like peptide-1 receptor agonists and nonsteroidal mineralocorticoid receptor antagonists, and interventions to control risk factors for CKD progression and cardiovascular events, such as blood pressure, glycemia, and lipids.
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SGLT2i and GLP1ra are widely endorsed by clinical practice guidelines.
“Sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1ra) are novel classes of medications for type 2 diabetes that significantly reduce cardiovascular deaths independent of their effect on hyperglycemia and are widely endorsed by clinical practice guidelines.4–11”
From Disparities in Use of Novel Diabetes Medications by Insurance: A Nationally Representative Cohort Study (2024) · cites this paper as [11]
SGLT2i and GLP1ra significantly reduce cardiovascular deaths independent of their effect on hyperglycemia.
“Sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1ra) are novel classes of medications for type 2 diabetes that significantly reduce cardiovascular deaths independent of their effect on hyperglycemia and are widely endorsed by clinical practice guidelines.4–11”
From Disparities in Use of Novel Diabetes Medications by Insurance: A Nationally Representative Cohort Study (2024) · cites this paper as [11]
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References 34 · Cited by 248
- Authors
- Navaneethan, S. D., Zoungas, S., Caramori, M. L., Chan, J. C. N., Heerspink, H. J. L., Hurst, C., Liew, A., Michos, E. D., Olowu, W. A., Sadusky, T., Tandon, N., Tuttle, K. R., Wanner, C., Wilkens, K. G., Craig, J. C., Tunnicliffe, D. J., Tonelli, M., Cheung, M., Earley, A., Rossing, P., de Boer, I. H., & Khunti, K.
- Affiliations
- Michael E. DeBakey VA Medical Center (US)
- Monash University (AU)
- University of Minnesota (US)
- Chinese University of Hong Kong (HK)
- University Medical Center Groningen (NL)
- Houston, Texas (C.H.)
- Mount Elizabeth Novena Hospital (SG)
- Johns Hopkins University (US)
- Obafemi Awolowo University Teaching Hospitals Complex (NG)
- Seattle, Washington (T.S.)
- All India Institute of Medical Sciences (IN)
- University of Washington (US)
- Universitätsklinikum Würzburg (DE)
- Northwest Kidney Centers (US)
- Flinders University (AU)
- The University of Sydney (AU)
- University of Calgary (CA)
- Kidney Disease: Improving Global Outcomes (BE)
- University of Copenhagen (DK)
- Kidney Research Institute, University of Washington, Seattle, Washington (I.H.B.)
- University of Leicester (GB)
- ORCID
- Navaneethan, Sankar D.
- Zoungas, Sophia
- Caramori, M. Luiza
- Chan, Juliana C.N.
- Heerspink, Hiddo J.L.
- Liew, Adrian
- Michos, Erin D.
- Tandon, Nikhil
- Tuttle, Katherine R.
- Wanner, Christoph
- Wilkens, Katy G.
- Craig, Jonathan C.
- Tunnicliffe, David J.
- Tonelli, Marcello
- Cheung, Michael
- Earley, Amy
- Rossing, Peter
- de Boer, Ian H.
- Khunti, Kamlesh
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2023-03
- Volume
- 176
- Issue
- 3
- Pages
- 381-387
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W4313855017
- Cited by
- 248
- References
- 34
- Citations by year
- 2026: 59 · 2025: 74 · 2024: 85 · 2023: 30
- FWCI
- 47.96
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Annals of Internal Medicine (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Figshare (submittedVersion, cc-by)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- U.S. Department of Veterans Affairs
- University of Minnesota
- Cleveland Clinic
- Cleveland Clinic Foundation
- University of Washington
- Johns Hopkins University
- Northwest Kidney Centers
- Steno Diabetes Center Copenhagen
- University of Leicester
- Rijksuniversiteit Groningen
- University of Sydney
- Monash University
- Flinders University
- Chinese University of Hong Kong
- Universitair Medisch Centrum Groningen
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- diabetes management, chronic kidney disease, type 2 diabetes, KDIGO guidelines, glucose-lowering therapy, SGLT2 inhibitors, GLP-1 receptor agonists, non-steroidal mineralocorticoid receptor antagonists, blood glucose monitoring, lifestyle intervention, cardiovascular risk, blood pressure control, lipid control, renal function preservation
- MeSH terms
- Sodium-Glucose Transporter 2 Inhibitors, Diabetes Mellitus, Type 2, Glucose, Humans, Kidney, Renal Insufficiency, Chronic
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