Most patients with type 2 diabetes and chronic kidney disease should be managed with SGLT-2 inhibitors as first-line therapy in addition to lifestyle interventions, according to new guidance.

International researchers, including Australian endocrinologist Professor Sophia Zoungas, also advise renin–angiotensin–aldosterone system (RAAS) blockade “at maximum tolerated dose” in those with comorbid hypertension and albuminuria.

The recommendations are contained in the recently updated Kidney Disease: Improving Global Outcomes Guidelines for managing diabetes in chronic kidney disease (CKD) released this month.

The update to the original guidelines — which were published just two years ago — was prompted by the rapid pace of advancement in treating type 2 diabetes and CKD, the authors said.