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Guidelines Updates at a Glance

Cardiovascular Disease (CVD) & Diabetes

For patients with type 2 diabetes and cardiovascular risk, SGLT2 inhibitors or GLP-1 receptor agonists reduce heart failure, kidney disease progression, stroke, and CV death — even when A1C is at target.

SGLT2i (empagliflozin, canagliflozin, dapagliflozin) → reduce heart failure, kidney progression, CV death.
GLP-1RA (dulaglutide, liraglutide, semaglutide) → reduce stroke and major CV events.
Combination therapy may provide additional benefit, though evidence is emerging.

Chronic Kidney Disease (CKD) & Diabetes

For patients with diabetes and CKD, SGLT2 inhibitors are first-line for renal and CV protection, with GLP-1 receptor agonists added for glucose, weight, or CV risk reduction.

SGLT2i → prioritize in CKD or heart failure; safe to initiate if eGFR ≥20 mL/min/1.73 m².
GLP-1RA → add for further benefit in glycemic or CV risk control.
Combine with ACEi/ARB, statins, and BP control (<130/80 mmHg); monitor electrolytes and kidney function closely.

Kidney Function Testing

Ongoing monitoring is essential, with frequency guided by patient risk.

At diagnosis: eGFR (CKD-EPI 2021) + urine ACR.
Annually: repeat in stable patients.
Abnormal results: repeat eGFR at 3 months, confirm with 2 additional uACR tests.
Every 3–6 months: if CKD, declining eGFR, or persistent albuminuria.
Cutoffs: ACR ≥3.0 mg/mmol = abnormal; eGFR <60 mL/min/1.73 m² signals risk.
New (2025): use KFRE in advanced CKD (G3–G5) to guide referral and risk stratification.