HbA1c and beyond

The Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on Diabetes Management in Chronic Kidney Disease from 2020 comes at an opportune time when progress in diabetes technology and therapeutics offer new options to manage the large population of patients with diabetes and CKD at high risk of poor health outcomes. Management of hemoglobin A1c is important in diabetes but an enlarging base of evidence from large clinical trials have demonstrated important new treatments offering organ protection and not just glucose management, such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists. It is the ambition that the guideline can help to optimize the clinical care of people with diabetes and CKD by integrating new options with existing management strategies based on high quality evidence. Here the focus has been on comprehensive care of patients with diabetes and CKD, glycemic monitoring and targets, antihyperglycemic therapies in patients with diabetes and CKD, and new developments since the guideline was published offering new opportunities and a wider target population for the new interventions.