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Content Update

May 23, 2022

Inclusion of Finerenone (Kerendia) in the 2022 American Diabetes Association Guidelines for Diabetes and Chronic Kidney Disease In 2021, the U.S. Food and Drug Administration (FDA) approved finerenone (Kerendia), a mineralocorticoid receptor antagonist (MRA), to reduce the risk of kidney disease progression, kidney failure, nonfatal heart attacks, cardiovascular death, and hospitalization for heart failure in adults with diabetic chronic kidney disease (CKD). The Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes (FIDELIO-DKD) clinical trial demonstrated significant differences with finerenone compared to placebo in the primary composite outcome of kidney failure, decrease in estimated glomerular filtration rate (eGFR) and death from renal causes. The 2022 American Diabetes Association (ADA) guidelines now include finerenone as an option for patients with type 2 diabetes and CKD who cannot tolerate a sodium-glucose cotransporter-2 inhibitor (SGLT2i).

LEARNING OBJECTIVES

LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Discuss the incidence of diabetes mellitus (DM).

  2. Distinguish clinical differences in type 1, Latent Autoimmune Diabetes of Adulthood, type 2, and gestational diabetes.

  3. List screening and diagnostic criteria for DM.

  4. Discuss therapeutic goals for blood glucose (BG) and blood pressure (BP) for a patient with diabetes.

  5. Recommend nonpharmacologic therapies, including meal planning and physical activity, for patients with diabetes.

  6. Compare oral agents used in treating diabetes by their mechanisms of action, time of action, side effects, contraindications, and effectiveness.

  7. Select appropriate insulin therapy based on onset, peak, and duration of action.

  8. Discuss the signs, symptoms, and treatment of hypoglycemia.

  9. Define diabetic ketoacidosis and discuss treatment goals.

  10. Develop a comprehensive therapeutic monitoring plan for a patient with diabetes based on patient-specific factors.

INTRODUCTION

Diabetes mellitus (DM) describes a group of chronic metabolic disorders. image DM is characterized by hyperglycemia that may result in long-term microvascular and neuropathic complications that contribute to DM being the leading cause of (a) new cases of blindness among adults, (b) end-stage renal disease, and (c) nontraumatic lower limb amputations. Macrovascular complications (coronary artery disease, peripheral vascular disease, and stroke) are also associated with DM.

EPIDEMIOLOGY

DM affects an estimated 34.2 million persons in the United States, or 10.5% of the population.1 Although an estimated 23.1 million persons have been diagnosed, another 7.2 million have DM but are unaware they have the disease.1 DM is characterized by a complete lack of insulin, a relative lack of insulin, or insulin resistance, as well as disorders of other hormones. These defects result in an inability to use glucose for energy. The increasing prevalence of DM is partly caused by three influences: lifestyle, ethnicity, and age.

Lifestyle

A sedentary lifestyle coupled with greater consumption of high-fat, high-carbohydrate foods, and larger portion ...

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