Alice Y.Y. Cheng, MD
Diabetes and kidney disease are so closely linked that the ADA and the American Society of Nephrology routinely sponsor a joint symposium at the Scientific Sessions. This year’s topic is anything but routine.
“Precision medicine has entered into the diabetic kidney disease space,” said Alice Y.Y. Cheng, MD, Associate Professor of Medicine at the University of Toronto. “There are potential new therapies to address diabetic kidney disease from a personalized medicine perspective—matching the right treatments to the right patients.”
Dr. Cheng will be the first presenter at this year’s Joint ADA/ASN Symposium—Cardiovascular and Renal Protection in Diabetes—Beyond SGLT2 Inhibitors and GLP-1 Receptor Agonists, which will begin at 8:00 a.m. Sunday in N-Hall E (North, Exhibition Level). While the symposium’s presenters will look ahead to future therapies, the discussion will be firmly rooted in the latest clinical data.
Peter Rossing, MD, DMSc
“We will start from new treatments and new trials, including CREDENCE, the first trial in diabetic kidney disease since 2001,” said Peter Rossing, MD, DMSc, Professor and Head of Diabetes Complications Research at the Steno Diabetes Center at the University of Copenhagen, Denmark. “For the first time in many years, we have new treatments that we can use to provide glycemic benefit and cardiovascular outcomes in patients with renal disease.”
The CREDENCE (Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation) trial is the first randomized, double-blind clinical outcome trial specifically designed and powered to assess the effects of an SGLT2i, canagliflozin, compared to placebo on major kidney outcomes. Data from CREDENCE will be presented at the 79th Scientific Sessions and could have a significant impact for type 2 diabetes patients at high renal risk.
Results from trials like CREDENCE are likely the first step in a new range of diabetes treatments with direct cardiorenal benefits, Dr. Rossing said. Diabetic kidney disease studies in type 1 diabetes are ongoing. The emerging cardiorenal benefits of diabetes drugs follow suggested therapeutic alternatives described in the ADA guidelines updated in 2018.
“We suggested using SGLT2 receptor agonists in patients with diabetes and kidney disease,” Dr. Rossing said. “Now we have the first hard outcomes confirming the expectations that so many had at this time last year. These guidelines and these new studies have real impact on our prescribing and our patients today.”
What’s now clear, he said, is that patients with established diabetic kidney disease should almost certainly be started on these new agents. It’s not yet clear if SGLT2 inhibitors can prevent or delay the development of kidney disease, but the question is being studied.
Another speaker, Aruna D. Pradhan, MD, MPH, Assistant Professor of Medicine at Harvard Medical School, will discuss the emergence of novel anti-inflammatory agents that offer new avenues for reducing cardiorenal risk in diabetes patients.
Diana Jalal, MD, Associate Professor of Nephrology at the University of Iowa, will discuss new treatment approaches using uric acid lowering therapy for cardiorenal protection in patients with both diabetes and chronic kidney disease.
“This is a look into the future, not more of the same-old, same-old,” Dr. Cheng said. “We are starting from the current space and going well beyond to talk and think outside the familiar diabetes box.”
