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Type 2 diabetes and CKD

Adults with CKD and type 2 diabetes ACR is 3mg /mmol or more Offer an angiotensin receptor blocker ( ARB ) or an angiotensin -converting enzyme ( ACE ) inhibitor -titrated 
to the highest dose that the person can tolerate

 

ACR is between
 3 – 30 mg /mmol already taking an ARB or ACE which has been titrated to the highest licensed dose that they can tolerate

AND 
 they meet the criteria in market authorization including adequate renal reserve ie eGFR thresholds

 

ACR is over 30 mg /mmol already taking an ARB or ACE which has been titrated to the highest licensed dose that they can tolerate 

AND
 they meet the criteria in market authorization including adequate renal reserve ie eGFR thresholds

 

Consider an SGLT2 inhibitor in
 addition to the the ARB or ACE

 

Offer an SGLT2 inhibitor in
 addition to the the ARB or ACE

 

evidence shows that SGLT2 inhibitors reduce the risk of CKD progression , mortality and cardiovascular events in adults with CKD and type 2 diabetes in people with ACR > 30 – SGLT2s are likely to be both more effective and cost saving in people with ACR of 3 – 30 – SGLT2s are likely to be both more cost effective and cost saving , however there was more uncertainty around the clinical and cost effectiveness in this group compared to the above group. The committee made a different recommendation as the SGLT-2 inhibitors may not be suitable for everyone with a baseline ACR of between 3 -30 mg/mmol

REFERENCE Type 2 diabetes in adults: management NICE guideline [NG28]Published:  Last updated: 

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