Comprehensive Management of Metabolic Abnormalities

Glycemic Management

The American Diabetes Association recommends initiating metformin as the foundation of therapy for patients with type 2 diabetes, with an eGFR of 96 mL/min/1.73m², as supported by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines 1, 2
The KDIGO guidelines recommend adding an SGLT2 inhibitor concurrently with metformin for patients with type 2 diabetes and chronic kidney disease (CKD) with eGFR ≥30 mL/min/1.73m², due to the proven cardiovascular and kidney benefits of this class 1, 2, 3
If glycemic targets are not achieved with metformin and SGLT2 inhibitor, the American Diabetes Association recommends adding a GLP-1 receptor agonist as the preferred next agent 1, 2, 3
The target HbA1c should be <7.0% for most adults with diabetes to reduce the risk of microvascular complications, as recommended by the American Diabetes Association 4, 5

The American College of Cardiology recommends initiating high-intensity statin therapy for patients with diabetes who have additional cardiovascular risk factors, with a target LDL cholesterol of <100 mg/dL 6, 5
The American Heart Association recommends reducing saturated fat intake to <7% of total daily calories and increasing intake of viscous fiber (10-25 g/day) and plant stanols/sterols (2 g/day) to help lower LDL cholesterol 6, 7

The American Heart Association recommends addressing elevated potassium levels before initiating renin-angiotensin-aldosterone system (RAS) blockade, and initiating an ACE inhibitor or ARB (but not both) as first-line therapy for patients with hypertension and albuminuria 4, 1, 5
The target blood pressure should be <140/90 mmHg, as recommended by the American Heart Association 5

The Academy of Nutrition and Dietetics recommends limiting sodium intake to <2 g per day and maintaining dietary protein intake at approximately 0.8 g/kg/day 1, 2
The American Heart Association recommends reducing saturated fat intake to <7% of total daily calories and increasing intake of viscous fiber (10-25 g/day) and plant stanols/sterols (2 g/day) to help lower LDL cholesterol 6, 7
The American College of Sports Medicine recommends moderate-intensity physical activity for at least 150 minutes per week, including both aerobic and resistance exercises 1, 2, 3

The National Kidney Foundation recommends monitoring serum creatinine and potassium levels when initiating ACE inhibitors, ARBs, or diuretics, and continuing to monitor urine albumin excretion to assess response to therapy and disease progression 4
The American Diabetes Association recommends reassessing cardiovascular risk factors at least annually and monitoring lipid profile after initiating statin therapy and periodically thereafter 4, 6, 5
The American Diabetes Association recommends rechecking HbA1c every 3-6 months to assess glycemic control 3