Recommendations

Document Overview

Design and created by Guideline Central in participation with the Kidney Disease Improving Global Outcomes and National Kidney Foundation.

Diabetes Management in Chronic Kidney Disease

Kidney Disease Improving Global Outcomes

National Kidney Foundation

Publication Date: Oct 1, 2020

Page Last Updated: May 6, 2026

Nomenclature and Description for Rating Guideline Recommendations

Grade	Strength of Recommendation
Level 1 (Strong Recommendation): “We recommend”	For the Patient	For the Clinician	Policy
Level 1 (Strong Recommendation): “We recommend”	Most individuals in this situation would want the recommended course of action and only a small proportion would not.	Most individuals in this situation would want the recommended course of action and only a small proportion would not. The majority of individuals in this situation would want the suggested course of action, but many would not.	The recommendation can be adopted as policy in most situations.
Level 2 (Conditional Recommendation /Suggestion) “We suggest”	The majority of individuals in this situation would want the suggested course of action, but many would not.	Different choices will be appropriate for different patients. Decision aids may well be useful in helping individuals making decisions consistent with their values and preferences. Clinicians should expect to spend more time with patients when working toward a decision.	The recommendation is likely to require substantial debate and involvement of stakeholders before policy can be determined.
NG	Not Graded

Grade	Quality of Evidence
A: High	We are confident that the true effect lies close to that of the estimate of the effect.
B: Moderate	The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
C: Low	The true effect may be substantially different from the estimate of the effect.
D: Very low	The true effect is likely to be substantially different from the estimate of effect.

Document Overview

Document Title: Diabetes Management in Chronic Kidney Disease

Authoring Societies

Kidney Disease Improving Global Outcomes

National Kidney Foundation

Document Publication Date: Oct 1, 2020

Page Last Reviewed/Updated: May 6, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: kdigo.org/guidelines/diabetes-ckd/

Source Citation: Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int. 2020 Oct;98(4S):S1-S115. doi: 10.1016/j.kint.2020.06.019. PMID: 32998798.

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: It is intended to assist the practitioner caring for patients with diabetes and CKD

Scope: Assessment and Screening, Management, Prevention, Treatment

Diseases/Conditions (MeSH)

D050171 - Dyslipidemias

D003920 - Diabetes Mellitus

D003922 - Diabetes Mellitus, Type 1

D003924 - Diabetes Mellitus, Type 2

D007676 - Kidney Failure, Chronic

D007674 - Kidney Diseases

D050171 - Dyslipidemias

D003920 - Diabetes Mellitus

D003922 - Diabetes Mellitus, Type 1

D003924 - Diabetes Mellitus, Type 2

D007676 - Kidney Failure, Chronic

D007674 - Kidney Diseases

Keywords: chronic kidney disease, diabetes, diabetes mellitus

Target Patient Population: Patients with diabetes and CKD

Inclusion Criteria: Male, Female, Adolescent, Adult, Older Adult

Health Care Settings: Ambulatory, Long Term Care, Outpatient

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Supplemental Methodology Resources: Methodology Supplement Data Supplement Data Supplement Data Supplement Data Supplement Data Supplement

Number of Source Documents: 468

Literature Search Start Date: Thursday, October 18, 2018

Literature Search End Date: Saturday, February 1, 2020

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Diabetes Management in Chronic Kidney Disease

Recommendations

Comprehensive care in patients with diabetes and CKD

Renin–angiotensin system (RAS) blockade

Smoking cessation

Glycemic monitoring and targets in patients with diabetes and CKD

Glycemic monitoring

Glycemic targets

Lifestyle interventions in patients with diabetes and CKD

Nutrition intake

Physical activity

Antihyperglycemic therapies in patients with type 2 diabetes (T2D) and CKD

Metformin

Sodium–glucose cotransporter-2 inhibitors (SGLT2i)

Glucagon-like peptide-1 receptor agonists (GLP-1 RA)

Approaches to management of patients with diabetes and CKD

Self-management education programs

Team-based integrated care

Nomenclature and Description for Rating Guideline Recommendations

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology