Kidney and heart protection in diabetes and chronic kidney disease
The steps that a joint consensus report from the American Diabetes Association and KDIGO gives for protecting the kidneys and heart in adults with diabetes and chronic kidney disease: screen every year and agree a comprehensive care plan built on lifestyle, then add medicines in turn: a blood pressure medicine when albuminuria is present, a statin, metformin, an SGLT2 inhibitor, a GLP-1 receptor agonist if needed, and finerenone for some people with type 2 diabetes and albuminuria.
- Care pathway
- In this atlas
Overview
Technical summary
Care pathway built only from the 2022 consensus report (PubMed record and PMC full text, hash only, cite only), using its consensus statements and its screening text, not the full guidelines of the two organizations. Each step cites one claim, which carries its own limits. The report also covers goals and monitoring of blood sugar, advanced kidney disease, transplant and other details, which are not recorded here, and it dates from 2022, so later trials and approvals are not covered. The care team and the person decide what applies to the person.
Applies to
- Recipient
- Adult
- Population
- Adults with type 1 or type 2 diabetes and chronic kidney disease (CKD). The report defines CKD as an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2, albuminuria (an albumin-to-creatinine ratio of 30 mg/g or more) or other signs of kidney damage that persist for at least 3 months. It gives no age limit.
- Care setting
- Not stated in the report.
- Geography
- Not stated in the report (a joint report of a US association and an international kidney organization)
- Life stage
- Adults, as the report's introduction puts it (adults with diabetes and CKD); the report gives no age bounds
- Follow-up
- Not applicable (guidance context)
Eligibility: 2 inclusion criteria; exclusion criteria not stated
- Included
- Type 1 or type 2 diabetes
- Chronic kidney disease as the report defines it
- Excluded
- None stated
Steps
-
Screen for kidney disease
If: People with type 1 or type 2 diabetes
Every year, people with diabetes have a urine albumin test and an eGFR blood test. Screening starts at diagnosis in type 2 diabetes and 5 years after diagnosis in type 1 diabetes. An abnormal result is confirmed, and kidney disease is diagnosed when it stays abnormal for at least 3 months.
The ADA/KDIGO consensus report says that both organizations recommend screening people with diabetes for chronic kidney disease (CKD) every year, with a urine albumin test and an estimated glomerular filtration rate (eGFR). Screening starts at diagnosis in type 2 diabetes and 5 years after diagnosis in type 1 diabetes. The report defines CKD as an eGFR below 60 mL/min/1.73 m2, albuminuria (an albumin-to-creatinine ratio of 30 mg/g or more) or other signs of kidney damage, and says the finding must persist for at least 3 months before the diagnosis is made.
Applies to Adult- Adults with type 1 or type 2 diabetes who have not yet been found to have chronic kidney disease (CKD), and those who have it. The report speaks of adults and gives no age bounds.
- Not stated in the report.
- Not stated in the report (a joint report of a US association and an international kidney organization)
- Adults, as the report's introduction puts it (adults with diabetes and CKD); the report gives no age bounds
- Certainty method
- Not assessed
- Limitations
- The report adds that screening is underused, especially for albuminuria, and that abnormal results should be confirmed. It gives no screening interval other than annual. This is guidance on screening, not evidence that screening improves outcomes. Only the PubMed record and the PMC full text were read. The report is joint ADA and KDIGO guidance drawn from the two organizations' 2022 guidelines, not a trial result, and its consensus statements carry no class of recommendation or level of evidence (the report points to the two organizations' own documents for those). It dates from 2022, so later trials and approvals are not covered. Its licence allows educational, not-for-profit use of the unaltered work, so this atlas restates the statement in its own words. PubMed lists no correction to the report (checked 2026-10-15).
- Last checked
- 2026-10-15
- Next evidence check due
- Not scheduled
Sources and citations (5)
-
- Locator
- Screening and Diagnosis, para 2 (annual screening)
- How it applies
- Annual screening.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- Screening and Diagnosis, para 2 (start of screening)
- How it applies
- Start of screening in type 2 and type 1 diabetes.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- Figure 1 caption
- How it applies
- Screening includes both urine albumin and eGFR; persistent abnormality diagnoses CKD.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- Screening and Diagnosis, para 1 (definition)
- How it applies
- CKD definition and the 3-month persistence rule.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- Introduction, para 4 (level of evidence)
- How it applies
- The consensus statements carry no level of evidence.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
Agree a comprehensive care plan
If: Type 1 or type 2 diabetes with CKD
The care team and the person agree a plan that starts with nutrition, exercise, stopping smoking and weight, and adds medicines aimed at preserving organ function, and treatment to reach targets for blood sugar, blood pressure and blood fats.
The ADA/KDIGO consensus report says that everyone with type 1 or type 2 diabetes and CKD should have a comprehensive care plan that the care team and the person work out and agree together. The base of the plan is nutrition, exercise, stopping smoking and weight. Medicines aimed at preserving organ function are added on that base, together with other treatment chosen to reach targets for blood sugar, blood pressure and blood fats.
Applies to Adult- Adults with type 1 or type 2 diabetes and chronic kidney disease (CKD). The report defines CKD as an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2, albuminuria (an albumin-to-creatinine ratio of 30 mg/g or more) or other signs of kidney damage that persist for at least 3 months. It gives no age limit.
- Not stated in the report.
- Not stated in the report (a joint report of a US association and an international kidney organization)
- Adults, as the report's introduction puts it (adults with diabetes and CKD); the report gives no age bounds
- Certainty method
- Not assessed
- Limitations
- The statement sets out a way of organizing care and names no particular medicine. The report's text adds that several treatments are usually needed, that they may need to be added one at a time with frequent checks, and that therapeutic inertia should be avoided. Only the PubMed record and the PMC full text were read. The report is joint ADA and KDIGO guidance drawn from the two organizations' 2022 guidelines, not a trial result, and its consensus statements carry no class of recommendation or level of evidence (the report points to the two organizations' own documents for those). It dates from 2022, so later trials and approvals are not covered. Its licence allows educational, not-for-profit use of the unaltered work, so this atlas restates the statement in its own words. PubMed lists no correction to the report (checked 2026-10-15).
- Last checked
- 2026-10-15
- Next evidence check due
- Not scheduled
Sources and citations (3)
-
- Locator
- Goals of Comprehensive Care, Consensus Statement
- How it applies
- The consensus statement on a comprehensive plan.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- Goals of Comprehensive Care, para 4 (therapeutic inertia)
- How it applies
- Several treatments, added in turn; avoid therapeutic inertia.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- Introduction, para 4 (level of evidence)
- How it applies
- The consensus statements carry no level of evidence.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
Treat high blood pressure with a renin-angiotensin system blocker
If: Type 1 or type 2 diabetes with high blood pressure and albuminuria
An ACE inhibitor or an angiotensin receptor blocker is recommended, raised to the largest dose that lowers blood pressure and can be tolerated.
The ADA/KDIGO consensus report recommends an ACE inhibitor or an angiotensin receptor blocker (ARB) for people with type 1 or type 2 diabetes who have high blood pressure and albuminuria. The dose is raised to the largest dose that lowers blood pressure and that the person can tolerate.
Applies to Adult- Adults with type 1 or type 2 diabetes who have high blood pressure and albuminuria. The report speaks of adults and gives no age bounds.
- Not stated in the report.
- Not stated in the report (a joint report of a US association and an international kidney organization)
- Adults, as the report's introduction puts it (adults with diabetes and CKD); the report gives no age bounds
- Certainty method
- Not assessed
- Limitations
- The statement applies only to people who have both high blood pressure and albuminuria. The report's text advises against combining an ACE inhibitor with an ARB for long-term use, because studies over longer periods found no gain and more adverse events. It says evidence for treating people who have albuminuria with normal blood pressure is less strong. Only the PubMed record and the PMC full text were read. The report is joint ADA and KDIGO guidance drawn from the two organizations' 2022 guidelines, not a trial result, and its consensus statements carry no class of recommendation or level of evidence (the report points to the two organizations' own documents for those). It dates from 2022, so later trials and approvals are not covered. Its licence allows educational, not-for-profit use of the unaltered work, so this atlas restates the statement in its own words. PubMed lists no correction to the report (checked 2026-10-15).
- Last checked
- 2026-10-15
- Next evidence check due
- Not scheduled
Sources and citations (3)
-
- Locator
- BP Management, Consensus Statement
- How it applies
- The consensus statement on an ACE inhibitor or ARB.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- ACE Inhibitors and ARBs, para 2 (combination, normal blood pressure)
- How it applies
- Avoid the combination; weaker evidence when blood pressure is normal.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- Introduction, para 4 (level of evidence)
- How it applies
- The consensus statements carry no level of evidence.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
Add a statin
If: Type 1 or type 2 diabetes with CKD; the report notes a possible exception for first-event prevention in people on dialysis
A statin is recommended, at moderate intensity to prevent a first atherosclerotic cardiovascular event and at high intensity for people who already have such disease and some people with several risk factors for it.
The ADA/KDIGO consensus report recommends a statin for everyone with type 1 or type 2 diabetes and CKD. The dose is of moderate intensity to prevent a first atherosclerotic cardiovascular event, and of high intensity for people who already have such disease and for some people who have several risk factors for it.
Applies to Adult- Adults with type 1 or type 2 diabetes and chronic kidney disease (CKD). The report defines CKD as an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2, albuminuria (an albumin-to-creatinine ratio of 30 mg/g or more) or other signs of kidney damage that persist for at least 3 months. It gives no age limit.
- Not stated in the report.
- Not stated in the report (a joint report of a US association and an international kidney organization)
- Adults, as the report's introduction puts it (adults with diabetes and CKD); the report gives no age bounds
- Certainty method
- Not assessed
- Limitations
- The report's text notes a possible exception: people whose kidney failure is treated with dialysis, in whom a statin started to prevent a first event has generally been ineffective. It endorses the ADA's wider advice on adding other lipid-lowering medicines but does not make it a consensus statement. Only the PubMed record and the PMC full text were read. The report is joint ADA and KDIGO guidance drawn from the two organizations' 2022 guidelines, not a trial result, and its consensus statements carry no class of recommendation or level of evidence (the report points to the two organizations' own documents for those). It dates from 2022, so later trials and approvals are not covered. Its licence allows educational, not-for-profit use of the unaltered work, so this atlas restates the statement in its own words. PubMed lists no correction to the report (checked 2026-10-15).
- Last checked
- 2026-10-15
- Next evidence check due
- Not scheduled
Sources and citations (4)
-
- Locator
- Lipid Management, Consensus Statement
- How it applies
- The consensus statement on a statin.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- Lipid Management, para 2 (dialysis exception)
- How it applies
- Possible exception for people on dialysis.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- Lipid Management, para 1 (ADA advice endorsed)
- How it applies
- The ADA's wider lipid advice is endorsed.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- Introduction, para 4 (level of evidence)
- How it applies
- The consensus statements carry no level of evidence.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
Use metformin when kidney function allows
If: Type 2 diabetes with CKD and an eGFR of 30 mL/min/1.73 m2 or higher
Metformin is recommended when eGFR is 30 or higher, at a lower dose of 1,000 mg a day when eGFR is 30 to 44 and in some people with an eGFR of 45 to 59 whose risk of lactic acidosis is high.
The ADA/KDIGO consensus report recommends metformin for people with type 2 diabetes and CKD whose eGFR is 30 mL/min/1.73 m2 or higher. It says to lower the dose to 1,000 mg a day when eGFR is 30 to 44, and for some people with an eGFR of 45 to 59 whose risk of lactic acidosis is high.
Applies to Adult- Adults who have both type 2 diabetes and chronic kidney disease and an estimated glomerular filtration rate (eGFR) of 30 mL/min/1.73 m2 or higher. The report speaks of adults and gives no age bounds.
- Not stated in the report.
- Not stated in the report (a joint report of a US association and an international kidney organization)
- Adults, as the report's introduction puts it (adults with diabetes and CKD); the report gives no age bounds
- Certainty method
- Not assessed
- Limitations
- The statement concerns metformin only when eGFR is 30 or higher; the report's text deals separately with lower kidney function. This atlas has no metformin record, so the claim sits on the report's own record. Only the PubMed record and the PMC full text were read. The report is joint ADA and KDIGO guidance drawn from the two organizations' 2022 guidelines, not a trial result, and its consensus statements carry no class of recommendation or level of evidence (the report points to the two organizations' own documents for those). It dates from 2022, so later trials and approvals are not covered. Its licence allows educational, not-for-profit use of the unaltered work, so this atlas restates the statement in its own words. PubMed lists no correction to the report (checked 2026-10-15).
- Last checked
- 2026-10-15
- Next evidence check due
- Not scheduled
Sources and citations (2)
-
- Locator
- ADA/KDIGO Consensus Statements, item 4 (metformin)
- How it applies
- The consensus statement on metformin and its dose limits.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- Introduction, para 4 (level of evidence)
- How it applies
- The consensus statements carry no level of evidence.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
Add an SGLT2 inhibitor
If: Type 2 diabetes with CKD and an eGFR of 20 mL/min/1.73 m2 or higher
Choose an SGLT2 inhibitor whose kidney or cardiovascular benefit has been shown; it can be continued if eGFR later falls below the starting level.
The ADA/KDIGO consensus report recommends a sodium-glucose cotransporter 2 (SGLT2) inhibitor with proven kidney or cardiovascular benefit for people with type 2 diabetes and CKD whose eGFR is 20 mL/min/1.73 m2 or higher. Once started, the medicine can be continued if eGFR later falls below that level.
Applies to Adult- Adults who have both type 2 diabetes and chronic kidney disease and an estimated glomerular filtration rate (eGFR) of 20 mL/min/1.73 m2 or higher. The report speaks of adults and gives no age bounds.
- Not stated in the report.
- Not stated in the report (a joint report of a US association and an international kidney organization)
- Adults, as the report's introduction puts it (adults with diabetes and CKD); the report gives no age bounds
- Certainty method
- Not assessed
- Limitations
- The report says direct evidence for starting an SGLT2 inhibitor at an eGFR of 20 to 29 is strongest for people who also have albuminuria or heart failure. The statement names a class; it is not about one substance. The report notes risks such as genital fungal infection and ketoacidosis in its text. Only the PubMed record and the PMC full text were read. The report is joint ADA and KDIGO guidance drawn from the two organizations' 2022 guidelines, not a trial result, and its consensus statements carry no class of recommendation or level of evidence (the report points to the two organizations' own documents for those). It dates from 2022, so later trials and approvals are not covered. Its licence allows educational, not-for-profit use of the unaltered work, so this atlas restates the statement in its own words. PubMed lists no correction to the report (checked 2026-10-15).
- Last checked
- 2026-10-15
- Next evidence check due
- Not scheduled
Sources and citations (4)
-
- Locator
- SGLT2i, Consensus Statement
- How it applies
- The consensus statement on an SGLT2 inhibitor.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- SGLT2i, para 3 (eGFR 20 to 29)
- How it applies
- Strength of the evidence at an eGFR of 20 to 29.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- SGLT2i, para 5 (risks)
- How it applies
- Ketoacidosis and genital fungal infection.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- Introduction, para 4 (level of evidence)
- How it applies
- The consensus statements carry no level of evidence.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
Add a GLP-1 receptor agonist if blood sugar is not at target
If: Type 2 diabetes with CKD, blood sugar not at the individual target with metformin or an SGLT2 inhibitor, or those medicines cannot be used
Choose a GLP-1 receptor agonist whose cardiovascular benefit has been shown.
The ADA/KDIGO consensus report recommends a GLP-1 receptor agonist whose cardiovascular benefit has been proven, for people with type 2 diabetes and CKD who do not reach their individual blood sugar target with metformin, an SGLT2 inhibitor or both, or who cannot use those medicines.
Applies to Adult- Adults who have both type 2 diabetes and chronic kidney disease and who do not reach their individual blood sugar target with metformin, an SGLT2 inhibitor or both, or who cannot use those medicines. The report speaks of adults and gives no age bounds.
- Not stated in the report.
- Not stated in the report (a joint report of a US association and an international kidney organization)
- Adults, as the report's introduction puts it (adults with diabetes and CKD); the report gives no age bounds
- Certainty method
- Not assessed
- Limitations
- The report says no completed trial had yet tested a GLP-1 receptor agonist for kidney disease outcomes; the kidney findings it cites come mostly from cardiovascular outcome trials, with one glycemic trial of dulaglutide in moderate to severe CKD. Its text advises against these medicines in people at risk of thyroid C-cell tumors, pancreatic cancer or pancreatitis, citing theoretical risks from preclinical models. The statement names a class and lists no single substance. Only the PubMed record and the PMC full text were read. The report is joint ADA and KDIGO guidance drawn from the two organizations' 2022 guidelines, not a trial result, and its consensus statements carry no class of recommendation or level of evidence (the report points to the two organizations' own documents for those). It dates from 2022, so later trials and approvals are not covered. Its licence allows educational, not-for-profit use of the unaltered work, so this atlas restates the statement in its own words. PubMed lists no correction to the report (checked 2026-10-15).
- Last checked
- 2026-10-15
- Next evidence check due
- Not scheduled
Sources and citations (4)
-
- Locator
- GLP-1 receptor agonists, Consensus Statement
- How it applies
- The consensus statement on a GLP-1 receptor agonist.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- GLP-1 Receptor Agonists, para 2 (no kidney outcome trial)
- How it applies
- No completed kidney outcome trial at the time.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- GLP-1 Receptor Agonists, para 3 (cautions)
- How it applies
- Cautions listed in the text.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- Introduction, para 4 (level of evidence)
- How it applies
- The consensus statements carry no level of evidence.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
Consider a nonsteroidal MRA (finerenone)
If: Type 2 diabetes, eGFR of 25 mL/min/1.73 m2 or higher, normal potassium and albuminuria (albumin-to-creatinine ratio of 30 mg/g or more) despite the largest tolerated dose of a renin-angiotensin system inhibitor
Choose a nonsteroidal mineralocorticoid receptor antagonist whose kidney and cardiovascular benefit has been shown. The report names finerenone as the only one with that proof when it was written.
The formal consensus statement of the ADA/KDIGO report names a drug class, not finerenone: it recommends a nonsteroidal mineralocorticoid receptor antagonist (ns-MRA) whose kidney and cardiovascular benefit has been proven, for people with type 2 diabetes, an eGFR of 25 mL/min/1.73 m2 or higher, a normal serum potassium and albuminuria (an albumin-to-creatinine ratio of 30 mg/g or more) despite the largest dose of a renin-angiotensin system (RAS) inhibitor that they can tolerate. The report names finerenone as the only ns-MRA with that proof and the only one approved anywhere to slow CKD progression and reduce cardiovascular events, and says adding finerenone is reasonable for people with type 2 diabetes who have persistent albuminuria despite standard treatment with glucose-lowering and blood pressure medicines.
Applies to Adult- Adults with type 2 diabetes who have an estimated glomerular filtration rate (eGFR) of 25 mL/min/1.73 m2 or higher, a normal serum potassium and albuminuria (an albumin-to-creatinine ratio of 30 mg/g or more) despite taking the largest dose of a renin-angiotensin system (RAS) inhibitor that they can tolerate. The report speaks of adults and gives no age bounds.
- Not stated in the report.
- Not stated in the report (a joint report of a US association and an international kidney organization)
- Adults, as the report's introduction puts it (adults with diabetes and CKD); the report gives no age bounds
- Certainty method
- Not assessed
- Limitations
- The formal consensus statement names the class and does not name finerenone. This claim sits on finerenone because the report's text and its Figure 3 note name finerenone as the only ns-MRA that met the statement's proviso when the report was written, so a later ns-MRA is not covered. The report's text also names esaxerenone, another ns-MRA, and says it lowered blood pressure and albuminuria but lacks long-term studies with clinical end points. The report advises a potassium check 4 weeks after any dose change and regular checks during treatment, and gives dosing and potassium limits that are not recorded here. The report's trial counts and percentages for finerenone are not recorded; the FIDELIO-DKD claim of this atlas carries that trial's figures. Only the PubMed record and the PMC full text were read. The report is joint ADA and KDIGO guidance drawn from the two organizations' 2022 guidelines, not a trial result, and its consensus statements carry no class of recommendation or level of evidence (the report points to the two organizations' own documents for those). It dates from 2022, so later trials and approvals are not covered. Its licence allows educational, not-for-profit use of the unaltered work, so this atlas restates the statement in its own words. PubMed lists no correction to the report (checked 2026-10-15).
- Last checked
- 2026-10-15
- Next evidence check due
- Not scheduled
Sources and citations (7)
-
- Locator
- ns-MRAs, Consensus Statement
- How it applies
- The consensus statement on an ns-MRA.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- Goals of Comprehensive Care, Figure 3 note
- How it applies
- Finerenone named as the only member of the class with proven benefit.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- ns-MRAs, para 2 (approval)
- How it applies
- Finerenone named as the only approved drug of the class for slowing CKD progression.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- ns-MRAs, para 4 (adding finerenone)
- How it applies
- Adding finerenone is called reasonable.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- ns-MRAs, para 5 (potassium monitoring)
- How it applies
- Potassium monitoring.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- ns-MRAs, para 2 (esaxerenone)
- How it applies
- Esaxerenone, another ns-MRA, lacks long-term end-point studies.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
-
- Locator
- Introduction, para 4 (level of evidence)
- How it applies
- The consensus statements carry no level of evidence.
- Retrieved
- Source effective date
- Not reported
- Source state
- Current
- Snapshot hash
18bc2637f4a3599a78fcf093fbd32cd604d294579ccd5970a51e0239e485aad7- Reuse basis
- PubMed record and PMC full text, fetched through NCBI E-utilities on 2026-10-15 (cib-pubmed-36189689.xml and cib-pmc-PMC9870667.xml). Only the hashes of the bytes are kept; nothing is committed. The PMC copy carries the American Diabetes Association's own licence, which permits use with a citation for teaching purposes without profit, provided the work is left unchanged. The publisher's licence page returned HTTP 403 to a script (cib-diabetesjournals-license.html) and was not worked around. The licence is not a Creative Commons licence and the atlas does not claim it is non-commercial in every use, so public text is cite_only: public pages restate the report in the atlas's own words, with a citation and a link, and show no quoted span. Quote rows are short evidence fragments for the reviewer.
Record details
- Record id
cardio:pathway-ckd-type-2-diabetes- Content hash
4cd230f8b96d07046f422fe14672b2c702fb9b67f0b672fd39418866a4ddadd4