Association of British Clinical Diabetologists and UK Kidney Association Joint Clinical Practice Guidelines for the Pharmacological Management of Hyperglycemia in Adults With Type 2 Diabetes Mellitus and CKD

TL;DR

This paper provides updated clinical guidelines for managing blood sugar in adults with type 2 diabetes and chronic kidney disease, focusing on effective medications and recent evidence.

Contribution

The paper offers updated, multidisciplinary clinical guidance based on recent trials for managing hyperglycemia in type 2 diabetes with CKD.

Findings

SGLT-2 inhibitors, nsMRAs, and GLP-1 RAs reduce kidney and cardiovascular risks in T2DM with CKD.

The guidelines summarize key recommendations and recent evidence for healthcare professionals treating T2DM and CKD.

Hyperglycemia and hypertension are key modifiable risk factors for CKD progression and CVD in diabetes.

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).

Hyperglycemia and hypertension are modifiable risk factors to prevent the onset and progression of CKD and related CVD. Recent clinical trials of people with type 2 diabetes mellitus (T2DM) and CKD have demonstrated reduction in composite kidney end point events (significant decline in kidney function, need for kidney replacement therapy, and kidney-related death) and cardiovascular risk with sodium-glucose cotransporter 2 (SGLT-2) inhibitors, nonsteroidal mineralocorticoid receptor antagonists (nsMRAs) and glucagon-like peptide 1 (GLP-1) receptor agonists (RAs).

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 hyperglycemia in adults with T2DM and CKD. This 2025 abbreviated updated guidance by a multidisciplinary group of health care professionals from primary and secondary care settings summarizes the key recommendations, clinical considerations and recent evidence that has implications for clinical practice for health care professionals who treat people with T2DM and CKD.

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