Table 2.

Recommendations for Glycemic Targets in DKD Patients

Professional Society/Group	Recommendations

KDOQI³⁵ KDIGO³⁶	Target HbA1c of 7% to prevent or # progression of microvascular complications of diabetesDo not recommend HbA1c <7% in individuals at risk of hypoglycemia Stages 4 and 5 CKD Patients on insulin or sulfonylureas Target HbA1c >7% in individuals with comorbidities, limited life expectancy, and risk of hypoglycemia
Consensus Conference on Chronic Kidney Disease and Diabetes: American Diabetes Association, American Society of Nephrology, and the National Kidney Foundation^37,38	Given the limitations of the most frequently used glycemic biomarker, HbA1c, and the high risk of hypoglycemia, specific decisions on therapy should be based on SMBG. Specific glycemic targets must consider overtreatment as well as undertreatment of blood glucose. Both preprandial and postprandial glycemic targets need to be individualized based on a patient’s knowledge and drug regimen, especially if it includes insulin. Although HbA1c levels between 7% and 8% appear to be associated with the highest survival rates in retrospective analyses of DKD patients, the imprecision of HbA1c measurements makes specific targets for people with DKD difficult to define. However, measurement of HbA1c still should be performed because the trending of the levels can assist in therapy decisions.

Abbreviations: CKD, chronic kidney disease; DKD, diabetic kidney disease; HbA1c, glycated hemoglobin; KDIGO, Kidney Disease Improving Global Outcomes; KDOQI, Kidney Disease Outcomes Quality Initiative; SMBG, self-monitoring of blood glucose.