Prevention and management of chronic kidney disease in type 2 diabetes

The HbA1c target may need to be individualized taking in to account history of hypoglycaemia and co-morbidities. (refer to NHMRC Evidence Based Guideline for Blood Glucose Control in Type 2 Diabetes at http://www.nhmrc.gov.au). Systolic blood pressure (SBP) appears to be the best indicator of the risk of CKD in type 2 diabetes. However, an optimum and safest lower limit of SBP has not been clearly defined. In people with type 2 diabetes antihypertensive therapy with ARB or ACEi decreases the rate of progression of albuminuria, promotes regression to normoalbuminuria, and may reduce the risk of decline in renal function. Due to potential renoprotective effects, the use of ACEi or ARB should be considered for the small subgroup of people with normal BP who have type 2 diabetes and microalbuminuria. The extent to which interventions with lipid lowering therapy reduces the development of CKD in people with type 2 diabetes is unclear. As there is limited evidence relating to effects of lipid treatment on the progression of CKD in people with type 2 diabetes, blood lipid profiles should be managed in accordance with guidelines for prevention and management of cardiovascular disease (CVD). Lifestyle modification (diet and physical activity) is an integral component of diabetes care (refer to the NHMRC Evidence Based Guidelines for Blood Glucose Control in Type 2 Diabetes), however, there are insufficient studies of suitable quality to enable dietary recommendations to be made with respect to prevention and/or management of CKD in people with type 2 diabetes. Evidence Based Guidelines for Blood Glucose Control in Type 2 Diabetes), however, there are insufficient studies of suitable quality to enable dietary recommendations to be made with respect to prevention and/or management of CKD in people with type 2 diabetes.