This transcript has been edited for clarity.
Jay H. Shubrook, DO: Hi. I'm Jay Shubrook, a family physician and diabetologist at Touro University in California. Today, we're going to talk about what to do with our patients who have diabetes and chronic kidney disease (CKD).
I'm delighted to have with me Dr Katherine Tuttle, who is a professor of medicine at the University of Washington. She is uniquely qualified to talk about this topic, as she is both an endocrinologist and a nephrologist, and she is on the board of directors of the Kidney Health Initiative. Thanks for joining me, Dr Tuttle.
Katherine R. Tuttle, MD: Thank you. It's a pleasure to be here with you today.
Shubrook: Many of my patients with type 1 and type 2 diabetes have CKD. Historically, I think about screening them to see whether they have changes in glomerular filtration rate (GFR) and/or albumin excretion in the urine. Let's say I find someone with a urine albumin-to-creatinine ratio less than 300 mg/g. What are the things I should be doing to help the patient, their kidneys, and their overall mortality?
Tuttle: The first thing is good glycemic control. We know from an abundance of evidence in both type 1 and type 2 diabetes that intensification of glycemic control, especially if initiated early in the course of diabetes, sustained over time, done safely, and avoiding hypoglycemia, is the best defense against microvascular complications—particularly nephropathy, which we now call "diabetic kidney disease." That is the cornerstone of good diabetes care and prevention of complications.
