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Updates from the 2025 American Diabetes Association guidelines on standards of medical care in diabetes
Instead, clinicians should start treatment early, including in combination, in an individualized manner, according to the clinical characteristics of the patients.38,71–80 On the other hand, although it is recommended that albuminuria is routinely assessed in patients with DM, independently of eGFR values at least once a year,11,12 this practice is uncommon, which leads to underdiagnosis of CKD.7 Measures of great interest and help to confirm albuminuria in clinical practice would be to standardize screening with uACR and eGFR measurement in primary care, the implementation of specific training and educational activities, and the use of new technologies.80,81 Regarding the latter, the use of the Nefroconsultor mobile app is a clinical decision support system that can improve appropriate referrals by 28%, as well as determine albuminuria at the time of referral.80,81 Another important measure would be to establish joint protocols with different hospital specialties involved in the management of this population (endocrinology, nephrology, internal medicine, cardiology), emphasizing the importance of continuity of care between different levels of care, where the roles of each professional and the criteria for referral to each of the specialties involved are clearly defined in protocols.5,12,82–85 Finally, to improve the management of patients with T2DM and CKD with albuminuria, we propose 10 recommendations, summarized in Table 7
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The obesity and metabolic disease burden (with over a billion overweight or obese individuals worldwide) ensures continued demand
