People with type 2 diabetes mellitus (T2DM) and diabetic kidney disease (DKD) are at increased risk of mortality alongside adverse cardiovascular (CV) and renal outcomes, with many progressing to end-stage kidney disease and requiring haemodialysis or kidney transplantation

In recent years, a growing body of evidence has emerged concerning the potential renoprotective effects of the sodium-glucose co-transporter 2 inhibitor (SGLT2i) class of medicines, with data from large T2DM CV outcome trials (CVOTS) demonstrating a significant reduction in markers for progression of kidney disease in addition to CV end points

In response, a new era of SGLT2i cardio-renal studies was initiated, with the canagliflozin CREDENCE trial (Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation) being the first to publish data demonstrating the effectiveness of this medicine in reducing the risk of both kidney failure and CV events in a population comprising individuals with T2DM and renal disease

The evolving evidence base in this area is reflected in the latest international guidelines for the treatment of T2DM, and this article aims to put these recommendations into context for clinicians supporting people with T2DM, outlining the relevant studies that have driven these changes and examining the potential mechanisms that may underly the renoprotective effect of SGLT2i treatments as well as the implications for clinical practice

The SGLT2i Prescribing Tool, previously developed by the Steering Committee, has also been updated to reflect much of the evidence discussed in this review and is available via the Diabetes Therapy website as a supplementary material