Both diabetes and kidney disease are leading causes of death worldwide. While about 20% of people with diabetes in the United States are undiagnosed, that number is significantly higher for those with chronic kidney disease (CKD).

“About 90% of people with kidney disease don’t know that they have it,” said Nilka Ríos Burrows, MT, MPH, Chronic Kidney Disease Initiative Lead in the Division of Diabetes Translation at the Centers for Disease Control and Prevention.

Burrows and a panel of experts will discuss the intersection of diabetes and kidney disease during the two-hour virtual presentation Doing Better for Diabetes and Chronic Kidney Disease (CKD), which will begin at 2:00 p.m. CT Friday, June 12, during the Scientific Sessions. A common theme will be the need to increase awareness, detection, and intervention for kidney disease in diabetes patients.

“In order to address early identification, it really requires a multidisciplinary approach that includes not just the primary care physician, but also the involvement of clinical pharmacists, policymakers, medical specialties, geneticists, clinical trialists, and information technology developers,” said Susanne Nicholas, MD, MPH, PhD, Associate Professor of Medicine at the University of California, Los Angeles, who will discuss identification of diabetes and CKD in clinical practice.

Dr. Nicholas and her colleagues at UCLA are exploring the use of artificial intelligence, clinical pharmacists, and electronic health digital alerts. Dr. Nicholas and another session presenter, Katherine R. Tuttle, MD, FACP, FASN, FNKF, are conducting an ongoing study with the largest chronic kidney disease, diabetes, prediabetes, and hypertension registry in the U.S., representing more than 3 million patients and about 12 years of collected work from electronic health records data.

“The focus is on early identification rather than just identification because it’s important to be able to identify patients who have diabetes and chronic kidney disease early in the course of their disease so they can be referred and managed appropriately to prevent some of the poor outcomes that are associated with the disease,” said Dr. Nicholas, adding that patients with diabetes who also have chronic kidney disease experience significantly reduced life expectancies, up to 16 years.

Burrows said one solution might be found in an approach used by the Indian Health Service—integrating CKD testing and case management as a part of routine diabetes care.

“If you see diabetes or hypertension, think kidney,” said Burrows, who will discuss the worldwide impact of diabetes and CKD. “That will increase awareness of kidney disease and early detection, and earlier intervention to prevent progression to kidney failure. Ultimately, preventing type 2 diabetes will help prevent kidney disease and kidney failure.”

Dr. Tuttle, Professor of Medicine at the University of Washington and Executive Director for Research at Providence Health Care, said confusion is common when identifying diabetic kidney disease versus nephropathy or diabetic nephropathy. Diabetic kidney disease is chronic kidney disease in a patient with diabetes based on having a high urine albumin or low glomerular filtration rate (GFR), or both, while diabetic nephropathy refers to a specific histologic or pathologic lesion in the kidney.

“Most patients don’t have kidney biopsies, so it turns out that in biopsy studies, most patients with type 1 ­­­diabetes—90-plus percent—will have classic diabetic nephropathy. But in type 2, about one-third of patients have nondiabetic kidney diseases, so we really can’t say that in patients with type 2 diabetes who have low GFR, albumin, or both that they specifically have diabetic nephropathy. But what we can say is they have CKD in diabetes, also known as DKD.”

These patients need treatment that is different than patients who have diabetes alone, but the established standard of care isn’t being implemented as widely as it needs to be, Dr. Tuttle said. For example, even though the use of an angiotensin-converting enzyme inhibitor or an angiotensin II receptor blocker has been recommended in DKD patients to control hypertension, they are being used in only 25% of patients.

Meanwhile, professional societies around the globe, including the ADA and the European Association for the Study of Diabetes, recommend sodium-glucose cotransporter 2 (SGLT2) inhibitors as the new standard of care for chronic kidney disease and heart disease in patients with type 2 diabetes. Better methods for dissemination and implementation are urgently needed to assure that these recommended therapies get to patients, Dr. Tuttle said.