Chronic kidney disease in type 1 diabetes: translation of novel type 2 diabetes therapeutics to individuals with type 1 diabetes.

Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada. VikasSrinivasan.Sridhar@uhn.ca. Division of Nephrology, University of Washington, Seattle, WA, USA. Kidney Research Institute, University of Washington, Seattle, WA, USA. Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland. Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland. Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia. Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. The George Institute for Global Health, Sydney, Australia. AdventHealth Translational Research Institute, Orlando, FL, USA. Steno Diabetes Center Copenhagen, Herlev, Denmark. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA. Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada.

Diabetologia. 2024;(1):3-18
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Abstract

Current management of chronic kidney disease (CKD) in type 1 diabetes centres on glycaemic control, renin-angiotensin system inhibition and optimisation of risk factors including blood pressure, lipids and body weight. While these therapeutic approaches have significantly improved outcomes among people with type 1 diabetes and CKD, this population remains at substantial elevated risk for adverse kidney and cardiovascular events, with limited improvements over the last few decades. The significant burden of CKD and CVD in type 1 diabetes populations highlights the need to identify novel therapies with the potential for heart and kidney protection. Over the last decade, sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide 1 receptor agonists and non-steroidal mineralocorticoid receptor antagonists have emerged as potent kidney-protective and/or cardioprotective agents in type 2 diabetes. The consistent, substantial kidney and cardiovascular benefits of these agents has led to their incorporation into professional guidelines as foundational care for type 2 diabetes. Furthermore, introduction of these agents into clinical practice has been accompanied by a shift in the focus of diabetes care from a 'glucose-centric' to a 'cardiorenal risk-centric' approach. In this review, we evaluate the potential translation of novel type 2 diabetes therapeutics to individuals with type 1 diabetes with the lens of preventing the development and progression of CKD.

Methodological quality

Publication Type : Review

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