Endocrine Abstracts

Unfortunately diabetes is a growing problem with now more than 537 million people worldwide having diabetes according to International Diabetes Federation. Excess morbidity and mortality in diabetes is related to the development of diabetic kidney disease seen in 30-40%, which not only causes end stage kidney disease, but also increases risk for cardiovascular events and mortality, which is the leading cause of death. Treatment of diabetic kidney disease has been control of glucose, lipids, and blood pressure including blockade of the renin angiotensin system, but the residual risk on optimal treatment was large. Multiple interventions have been tested and failed in this condition, but in the past few years, we have suddenly been able to find new treatment options. First cardiovascular outcome trials in diabetes found the SGLT2 inhibitors reduced progression of kidney disease or heart failure, and GLP1 receptor agonists reduced cardiovascular events and maybe also improved kidney parameters. Then an endothelin receptor antagonist demonstrated reduced progression of kidney disease, and most recently the nonsteroidal mineralocorticoid receptor antagonist finerenone demonstrated reduction in progression of kidney and cardiovascular disease. Now we suddenly have the opportunity to improve on the most deadly complications to diabetes with several interventions, and as they work on different disease pathways (hemodynamic, metabolic, inflammatory) data suggest they can be combined with extra benefit for the person with diabetes. Now implementation is key, and quality monitoring systems should be in place to ensure this.