Abstract

A growing and significant number of people with diabetes develop chronic kidney disease (CKD) and diabetes related CKD is a leading cause of end-stage kidney disease (ESKD). People with diabetes and CKD have high morbidity and mortality, predominantly related to cardiovascular disease (CVD). Hyperglycaemia and hypertension are modifiable risk factors to prevent onset and progression of CKD and related CVD. Recent clinical trials of people with type 2 diabetes and CKD have demonstrated reduction in composite kidney endpoint events (significant decline in kidney function, need for kidney replacement therapy and kidney related death) and cardiovascular risk with sodium glucose co-transporter-2 (SGLT-2) inhibitors, non-steroidal mineralocorticoid receptor antagonists (nsMRAs) and glucagon-like peptide 1 (GLP-1) receptor agonists. The Association of British Clinical Diabetologists and UK Kidney Association Diabetic Kidney Disease Clinical Speciality Group have previously undertaken a narrative review and critical appraisal of the available evidence to inform clinical practice guidelines for the pharmacological management of hyperglycaemia in adults with type 2 diabetes and CKD. This 2025 abbreviated updated guidance from a multidisciplinary group of healthcare professionals from primary and secondary care settings summarises the key recommendations and recent evidence that has implications for clinical practice for health care professionals who treat people with type 2 diabetes and CKD