Diabetes renal disease (DKD) is a common microvascular complication among diabetes patients, and its management strategy requires a combination of early screening, lifestyle adjustments, drug treatment, disease surveillance and later management.
1. Early screening and prevention: for diabetics, particularly type 2 and type 1 diabetes (more than five years) patients, at least once a year should be screened for urinary routines, urinary protein/ecstasy (UACR) and blood acetic anhydride (calculating eGFR) for early detection of DKD. In addition, patients with diabetes should undergo regular and comprehensive physical examinations to assess the risk of complications and to provide comprehensive treatment and management on the recommendation of a doctor.
2. Lifestyle adjustments: Diabetes patients should have reasonable control of total calories to reach or maintain their desired body weight. For patients with trace protein urine, daily protein intake should not exceed 15 per cent of total calories. Momentum activity helps control blood sugar and blood pressure and slows progress on DKD.
3. Drug treatment: blood sugar control: individualized blood sugar control targets, based on age, pathology, life expectancy, combinations, complications, low blood sugar risk, etc. Blood pressure control: DKD patients have a blood pressure control target below 130/80 mmHg, which should not be below 60 mmHg. Deductive medicines: The combination of sodium-glucose and new drugs such as SGLT2i and insulin-synthetic agonists (GLP-1RA) provide evidence of organ protection and should be considered as a first-line treatment. ACEI/ARB: Rational use of ACEI/ARB-type drugs to reduce or delay the occurrence of ESRDs for DKD patients with protein urine or eGFR drops.
Disease surveillance: adjusting the frequency of follow-up visits to monitor kidney function and urine protein levels based on the risks of progress of the DKD. Measures such as regular monitoring of blood sugar, control of hypertension and blood resin abnormalities and maintenance of a healthy lifestyle can effectively prevent the occurrence of chronic complications of diabetes.
5. Advanced management: consideration of kidney substitution treatment, such as dialysis or kidney transplants, for patients with advanced DKD. At the same time, the management of ESRD-related complications reduces the risk of cardiovascular events and deaths and improves the quality of life and life expectancy.
6. Integrated care: formation of teams of services, including family doctors, nurses, public health personnel, etc., to provide integrated services to DKD patients, in collaboration with the division of labour among specialists in secondary and higher health institutions. Diabetes education is at the core, and health-care providers should systematize and professionalize the education and guidance of patients, so that they have the knowledge and ability to live with diabetes for life, to exercise their subjectivity, to adopt effective self-management methods and to cooperate with treatment for life.
These strategies have made it possible to effectively manage diabetes and kidney diseases, slow the progress of the disease, reduce complications and improve the quality of life of patients. At the same time, diabetes patients should work closely with the medical team to manage diabetes to reduce the risk of acute complications. Through these measures, people with diabetes can better protect their health and reduce the risks of acute complications.
