The most common cause of kidney failure in the United States and across the world is diabetes mellitus (DM). Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in persons with diabetes, and chronic kidney disease (CKD) further increases overall CVD risk. It is important to individualize glycemic targets for patients to maintain glucose levels that will reduce the development and progression of complications while avoiding hypoglycemia. CKD alters the relationship of glucose levels to measures of long-term control, such as hemoglobin A_1c. Medications used to treat DM may need dose adjustments as CKD progresses. Some medications have particular characteristics in patients with CKD. Insulin and sulfonylureas increase the risk of hypoglycemia, some glucagon-like peptide 1 receptor agonists reduce the risk of CVD outcomes, and most sodium/glucose cotransporter 2 inhibitors reduce the risk of CKD and CVD outcomes. Therefore, for the individual patient, changes in medication types and doses may need constant attention as CKD progresses.

在美国和世界范围内，导致肾衰竭的最常见原因是糖尿病 (DM)。心血管疾病 (CVD) 是糖尿病患者发病和死亡的主要原因，而慢性肾病 (CKD) 进一步增加了整体 CVD 风险。重要的是为患者制定个体化血糖目标以维持血糖水平，这将减少并发症的发展和进展，同时避免低血糖。CKD 改变了血糖水平与长期控制措施的关系，例如血红蛋白 A _1c. 随着 CKD 的进展，用于治疗 DM 的药物可能需要调整剂量。一些药物在 CKD 患者中具有特殊的特征。胰岛素和磺脲类药物会增加低血糖的风险，一些胰高血糖素样肽 1 受体激动剂会降低 CVD 结局的风险，大多数钠/葡萄糖协同转运蛋白 2 抑制剂会降低 CKD 和 CVD 结局的风险。因此，对于个体患者，随着 CKD 的进展，药物类型和剂量的变化可能需要持续关注。