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Chronic kidney disease in type 1 diabetes: translation of novel type 2 diabetes therapeutics to individuals with type 1 diabetes – published online 06/10/2023

Sridhar graphical abstract

Vikas S. Sridhar, Christine P. Limonte, Per‑Henrik Groop, Hiddo J. L. Heerspink, Richard E. Pratley, Peter Rossing, Jay S. Skyler, David Z. I. Cherney

Over the past 20 years, the treatment of chronic kidney disease (CKD) in type 1 and type 2 diabetes has focused on glycaemic and blood pressure control, especially, in the latter case, using renin–angiotensin system (RAS) blockers. However, little progress has been made since RAS inhibitor trials demonstrated a slowing of CKD progression, especially in type 1 diabetes. Consequently, individuals with type 1 or type 2 diabetes have a high residual risk of CKD and CVD, and life expectancy for children with type 1 diabetes is reduced, highlighting the urgent need to make progress. However, there is optimism for people with type 2 diabetes. In type 2 diabetes, sodium–glucose cotransporter-2 inhibitors, glucagon-like peptide 1 receptor agonists and non-steroidal mineralocorticoid receptors antagonists have become the standard of care for reducing adverse kidney and cardiovascular outcomes, shifting the focus from a ‘glucose-centric’ to a ‘cardiorenal risk-centric’ approach. In this issue, Sridhar and Limonte et al (https://doi.org/10.1007/s00125-023-06015-1) evaluate the potential translation of these type 2 diabetes therapeutics to individuals with type 1 diabetes, with the lens of preventing the development and progression of CKD. The authors conclude that, considering the mechanistic overlap in the development and progression of CKD in type 1 and type 2 diabetes, there is a strong rationale for developing novel CKD therapies for use in both type 1 and type 2 diabetes and for repurposing existing type 2 diabetes CKD therapies for the treatment of CKD in people with type 1 diabetes. The figure from this review is available as a downloadable slide

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