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. 2024 Spring;42(2):274-294.
doi: 10.2337/cd23-0063. Epub 2023 Dec 6.

Diabetic Kidney Disease Prevention Care Model Development

Nuha A ElSayed  1   2 , Raveendhara R Bannuru  1 , George Bakris  3 , Joan Bardsley  4 , Ian H de Boer  5 , Robert A Gabbay  1 , Janet Gockerman  6 , Rozalina G McCoy  7 , Elaine McCracken  1 , Joshua J Neumiller  8   9 , Scott J Pilla  10 , Connie M Rhee  11
Affiliations

Diabetic Kidney Disease Prevention Care Model Development

Nuha A ElSayed et al. Clin Diabetes. 2024 Spring.

Abstract

More than one-third of people with diabetes develop diabetic kidney disease (DKD), which substantially increases risks of kidney failure, cardiovascular disease (CVD), hypoglycemia, death, and other adverse health outcomes. A multifaceted approach incorporating self-management education, lifestyle optimization, pharmacological intervention, CVD prevention, and psychosocial support is crucial to mitigate the onset and progression of DKD. The American Diabetes Association convened an expert panel to develop the DKD Prevention Model presented herein. This model addresses prevention and treatment, including screening guidelines, diagnostic tools, and management approaches; comprehensive, holistic interventions; well-defined roles for interdisciplinary health care professionals; community engagement; and future directions for research and policy.

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Conflict of interest statement

No potential conflicts of interest relevant to this article were reported.

Figures

Figure 1
Figure 1
Factors influencing the reduction of DKD incidence. EHR, electronic health record; PWD, people with diabetes; w/o, without.
Figure 2
Figure 2
Factors influencing the reduction of progression of early DKD. EHR, electronic health record; PWD, people with diabetes; w/, with.
Figure 3
Figure 3
Interventions for DKD prevention and their key stakeholders. *Inclusive of interdisciplinary team members.
Figure 4
Figure 4
Factors indicating the need for further evaluation of kidney disease etiology. AKI, acute kidney injury; RBC, red blood cell; SLE, systemic lupus erythematosus; T1D, type 1 diabetes; WBC, white blood cell.
Figure 5
Figure 5
Screening and monitoring for DKD: the KDIGO Heat Map. Numbers in the boxes are the number of times per year to screen or monitor. Adapted from ref. 45.
Figure 6
Figure 6
Pillars of therapy to reduce cardiorenal risk.
Figure 7
Figure 7
Holistic approach to improving outcomes in individuals with diabetes and CKD. eGFR values are expressed as mL/min/1.73 m2. ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; HTN, hypertension; MRA, mineralocorticoid receptor antagonist; PCSK9i, proprotein convertase subtilisin/kexin type 9 inhibitor; RA, receptor agonist; SGLT2i, SGLT2 inhibitor; T1D, type 1 diabetes; T2D, type 2 diabetes.
Figure 8
Figure 8
DSMES services covered by CMS for people with diabetes. RD/RDN, registered dietitian/registered dietitian nutritionist.
Figure 9
Figure 9
Community involvement for health promotion.
See this image and copyright information in PMC

References

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