Preventing Kidney Disease in Diabetic Patients

Diabetes is a chronic disease that affects the way your body turns food into energy. According to the World Health Organization (WHO), diabetes ranks in the top 10 causes of death worldwide, with an estimated 1.5 million deaths. In the United States, over 29 million people have diabetes and over 88 million people live with prediabetes.

The three main types of diabetes are:

• type 1 (insulin dependent),
• type 2 diabetes, and;
• gestational diabetes (diabetes in pregnancy).

Living with diabetes increases the risk of developing other diseases such as coronary artery disease, heart attacks, strokes, and is the leading cause of kidney failure. About 1 in 3 American adults with diabetes also has Chronic Kidney Disease (CKD). Living with both diabetes and CKD can be challenging but manageable. With the help of medication therapy and lifestyle changes, people living with the disease are able to manage their disease and live normal lives.

Preventing Chronic Kidney in Diabetic Patients

Managing your diabetes is key in preventing CKD from occurring. This can be done by learning healthy eating habits, exercising and sticking to your medication schedule. A healthy diabetic diet includes eating lots of low sugar fruits, vegetables, healthy fats and lean proteins. It is important to limit salt, sugar and foods high in carbohydrates such as soda, cookies, and crackers.

Depending on your age and activity level, exercising regularly can help keep a steady blood sugar level. At different stages of kidney disease, you may also need to reduce the amount of potassium, phosphorus and protein in your diet. More specifically, you need to avoid vegetables that are high in carbohydrates and fruits high in sugar such as bananas, melons and grapes. By visiting the American Diabetes Association website (https://www.diabetes.org/healthy-living/recipes-nutrition), you can find more information about healthy living with diabetes.

Dietary changes can greatly improve symptoms and people can even reach a diabetic remission, meaning that your A1c levels (3-month blood sugar test) are below that of prediabetes for at least 1 year without needing to take any diabetes medications. It is suggested that maintaining a low or very low carbohydrate diet for six months might achieve diabetes remission. A low carbohydrate diet is one where less than 26-45% of daily calories are from carbohydrates (less than 130g to225g/day).

Managing Your Medications

For people with diabetes, it is important to monitor and meet blood sugar targets as often as possible. It is also recommended to have A1c levels tested up to four times a year but at least twice a year for all diabetics to track disease progress. There are many types of drugs working in different ways to help lower your blood sugars. It is common for your doctor to prescribe a combination of different medications to better control your blood sugars. Talking with your doctor and pharmacists can help you better understand what medications you are being prescribed and how you should be taking those medications (what doses and how often).

Medication to Manage Kidney Disease in Diabetic Patients

Since diabetics are at a higher risk of developing kidney disease, it is important to minimize those risks with medications and lifestyle changes. For those living without established kidney disease, managing blood glucose and lower A1c levels is necessary to prevent the development of disease. For those with established Chronic Kidney Disease, it is recommended to add-on a Sodium-Glucose Co-Transporter-2 inhibitor (SGLT2i) or a Glucagon-Like Peptide -1 antagonist (GLP-1a). SGLT2 inhibitors (canagliflozin, empagliflozin and dapagliflozin) and GLP-1 antagonists (liraglutide, semaglutide, and dulaglutide) are beneficial in preventing the progression of Diabetic Kidney Disease.

Recently, the FDA approved dapagliflozin as the first SGLT-2 inhibitor for the treatment of CKD regardless of diabetes status. Apart from their benefit in preventing the progression of kidney disease, both SGLT2i and GLP-1a are also known to provide benefits to those with established coronary vascular disease, and heart failure. Although these medications are highly effective, they are still brand name only medications meaning they carry a steeper cost to purchase.

Key Take-Home Points

As a person with pre-diabetes or diabetes, it is important to take care of yourself. Changes to your normal day, such as diet and exercise, can help you prevent further complications of the disease. Talking with your doctor about your diabetes will help you better understand how to get your blood sugars under control. Ask your doctor what treatment options are best for you, in order to achieve your goals.

References:

1. https://www.who.int/news-room/fact-sheets/detail/diabetes
2. https://www.cdc.gov/diabetes/basics/quick-facts.html
3. https://www.kidney.org/news/newsroom/factsheets/Diabetes-And-CKD
4. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
5. https://www.cdc.gov/diabetes/basics/index.html
6. https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444#:~:text=Diabetes%20dramatically%20increases%20the%20risk,Nerve%20damage%20(neuropathy).
7. American Diabetes Association (2021). Standards of Medical Care in Diabetes-2021. Diabetes care, 44(Suppl 1), S15–S33. https://doi.org/10.2337/dc21-S002
8. Goldenberg, J. Z., & Johnston, B. C. (2021). Low and very low carbohydrate diets for diabetes remission. BMJ (Clinical research ed.), 373, n262. https://doi.org/10.1136/bmj.n262