Diabetic kidney disease is the most frequent cause of kidney failure, accounting for half of all cases worldwide. Moreover, deaths from diabetic kidney disease increased 106% between 1990 and 2013, with most attributed to cardiovascular disease. Recommended screening and monitoring for diabetic kidney disease are conducted in less than half of patients with diabetes. Standard-of-care treatment with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker is correspondingly low. Sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and a nonsteroidal mineralocorticoid antagonist are highly effective therapies to reduce kidney and cardiovascular risks in diabetic kidney disease. However, <20% of eligible patients are receiving these agents. Critical barriers are high out-of-pocket drug costs and low reimbursement rates. Data demonstrating clinical and cost-effectiveness of diabetic kidney disease care are needed to garner payer and health care system support. The pharmaceutical industry should collaborate on value-based care by increasing access through affordable drug prices. Additionally, multidisciplinary models and communication technologies tailored to individual health care systems are needed to support optimal diabetic kidney disease care. Community outreach efforts are also central to make care accessible and equitable. Finally, it is imperative that patient preferences and priorities shape implementation strategies. Access to care and implementation of breakthrough therapies for diabetic kidney disease can save millions of lives by preventing kidney failure, cardiovascular events, and premature death. Coalitions composed of patients, families, community groups, health care professionals, health care systems, federal agencies, and payers are essential to develop collaborative models that successfully address this major public health challenge.

糖尿病肾病是肾衰竭最常见的原因，占全球所有病例的一半。此外，1990年至2013年间，糖尿病肾病导致的死亡人数增加了106%，其中大部分归因于心血管疾病。建议对不到一半的糖尿病患者进行糖尿病肾病筛查和监测。使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂的标准护理治疗相对较低。钠-葡萄糖协同转运蛋白 2 抑制剂、胰高血糖素样肽 1 受体激动剂和非类固醇盐皮质激素拮抗剂是降低糖尿病肾病肾脏和心血管风险的高效疗法。然而，<20% 的符合条件的患者正在接受这些药物治疗。关键障碍是高昂的自付费用和较低的报销率。需要证明糖尿病肾病护理的临床和成本效益的数据来获得付款人和医疗保健系统的支持。制药行业应通过负担得起的药品价格来增加可及性，从而在基于价值的护理方面进行合作。此外，需要针对个人医疗保健系统量身定制的多学科模型和通信技术来支持最佳的糖尿病肾病护理。社区外展工作对于提供可及且公平的护理也至关重要。最后，患者的偏好和优先事项必须影响实施策略。获得糖尿病肾病护理和实施突破性疗法可以通过预防肾衰竭、心血管事件和过早死亡来挽救数百万人的生命。 由患者、家庭、社区团体、医疗保健专业人员、医疗保健系统、联邦机构和付款人组成的联盟对于开发成功应对这一重大公共卫生挑战的合作模式至关重要。