Type 2 diabetes is on the upswing around the world as more patients develop obesity. Not surprisingly, diabetic kidney disease is also trending upward.
“Diabetes is one of the leading causes of chronic and end-stage kidney disease,” said Amy K. Mottl, MD, MPH, FASN, Associate Professor of Nephrology and Hypertension at the University of North Carolina, Chapel Hill. “And kidney disease is one of the primary factors that lead to increased morbidity and mortality among people with diabetes. We have to involve professionals from diabetology, nephrology, and primary care to get the kind of multidisciplinary care that can improve screening, uptake of clinical practice guidelines, and ultimately improve patient outcomes and satisfaction with our care.”
Dr. Mottl will open the Joint ADA/ASN Symposium—Turning the Tides—Diagnosing, Preventing, and Treating Diabetic Kidney Disease Early on Monday, June 6. The symposium, which begins at 2:15 p.m. CT in La Nouvelle Orleans Ballroom C at the convention center, will also be livestreamed for virtual meeting attendees.
The joint symposium brings together experts from diabetology and kidney disease to help break through the silos that have traditionally separated specialties.
“Most patients with kidney disease don’t know they have it,” Dr. Mottl said. “We need to increase the rates of screening for kidney disease, which means involving pharmacists, physician extenders, nurses, and a population of professionals who are involved in the care of patients with diabetes and kidney disease.”
Indeed, the legacy clinical measures in use today are a challenge, said Monika A. Niewczas, MD, PhD, MPH, Assistant Investigator at Joslin Diabetes Center and Assistant Professor at Harvard Medical School.
“Legacy clinical measures do not entirely explain the disease course,” Dr. Niewczas said. “We need to perform comprehensive molecular phenotyping to learn who to treat and to identify new therapies.”
Recent advances in proteomics at Joslin and other centers are furthering the field by producing new insights into possible determinants of kidney disease progression. Sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, both developed as diabetes treatments, ended a years-long drought in new therapeutic approaches to diabetic kidney disease. Both classes are associated with clinically significant weight loss in addition to other favorable clinical effects in diabetes, kidney disease, and cardiovascular disease.
Bariatric surgery is another approach that can improve both diabetes and kidney care, Dr. Niewczas added.
“We can use bariatric surgery to put people with diabetes into remission,” said Carel le Roux, FRCP, PhD, Professor in the Diabetes Complications Research Centre at University College in Dublin, Ireland. “Nobody dies directly from high body weight or high glucose levels; they die from the complications of obesity and diabetes like kidney disease. When we use bariatric surgery to drive obesity and diabetes into remission, we also drive down their risk of complications like kidney disease. That is a practice-changing realization.”
Bariatric surgery has long been a difficult sell to people with diabetes, Dr. le Roux added. Losing weight is not a compelling argument for many people to accept surgery.
“But if we explain to patients that going under the knife is going to reverse their diabetes and reduce their risk of complications that will potentially make them die earlier, now they are more willing to consider all options,” he said. “The same goes for diabetologists and nephrologists. Bariatric surgery is a treatment they do in conjunction with colleagues, just like preparing a patient for a kidney transplant or ordering laser coagulation for a patient with diabetic retinopathy. Bariatric surgery is a novel approach that can change your practice for the better.”
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