Addressing unmet needs for chronic kidney disease treatment in type 1 diabetes: A review

Abstract

Chronic kidney disease (CKD) is a serious complication occurring in nearly one of three people with type 1 diabetes (T1D). Major therapeutic advances have been made in the management of CKD for people with type 2 diabetes (T2D), thereby improving their kidney, cardiovascular, and survival outcomes. However, people with T1D were largely excluded from these CKD therapeutic development programmes. Recent treatment advancements for people with T2D include the introduction of sodium-glucose cotransporter 2 inhibitors, a nonsteroidal mineralocorticoid antagonist, and glucagon-like peptide-1 receptor agonists. The development and progression of CKD in people with T1D are driven by a constellation of risk factors such as hyperglycemia, hypertension, obesity, and others that share common mechanistic links with T2D. As such, a compelling rationale exists for focused studies of these therapeutic classes for the treatment of CKD in T1D. Additionally, care provided by a coordinated team of primary care clinicians, endocrinologists, nephrologists, and cardiologists is central to therapeutic implementation. There is a major unmet need for improved treatments for CKD in people with T1D. Ongoing and future studies will help to establish whether proven therapies for CKD in T2D are also safe and efficacious in people with T1D. Coordinated, cross-specialty approaches to awareness, detection, and intervention for CKD are also needed to improve kidney, cardiovascular, and survival outcomes in people with T1D.

Keywords: GLP‐1 analogue; cardiovascular disease; diabetic nephropathy; type 1 diabetes, SGLT2 inhibitor.