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Real-Life Cases of Patients With Type 2 Diabetes and Chronic Kidney Disease: A Practice Challenge

  • Authors: Roberto Pecoits-Filho, MD, PhD
  • CME Released: 2/24/2023
  • Valid for credit through: 2/24/2024, 11:59 PM EST
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  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    You Are Eligible For

    • Letter of Completion

Target Audience and Goal Statement

This activity is intended for primary care physicians (PCPs); nephrologists, diabetologists, and endocrinologists; and cardiologists.

The goal of this activity is for learners to be better able to acknowledge serious health risks associated with chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) and the availability of novel treatment options shown to reduce the risk of associated complications.

Upon completion of this activity, participants will:

  • Have increased knowledge regarding the
    • Latest international society guideline recommendations for management of patients with CKD and T2D
    • Safety aspects of novel, selective nonsteroidal mineralocorticoid receptor antagonists (ns MRAs) for reducing the risk of CKD progression and cardiovascular (CV) risk reduction in patients with CKD
  • Have greater competence related to
    • Regular assessment of kidney function in patients with T2D
    • Practical use of novel mineralocorticoid receptor antagonists (MRAs) in appropriate patients with CKD and T2D


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All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.

Disclosures for additional planners can be found here.


  • Roberto Pecoits-Filho, MD, PhD

    Scientific Director
    Arbor Research Collaborative for Health
    Ann Arbor, Michigan


    Roberto Pecoits-Filho, MD, PhD, has the following relevant financial relationships:
    Consultant or advisor for: Akebia Therapeutics; AstraZeneca; Bayer AG; Boehringer-Lilly; Fresenius Medical Care; Novo Nordisk
    Speaker or member of speakers bureau for: Akebia Therapeutics; AstraZeneca; Boehringer-Lilly; Fresenius Medical Care; Novo Nordisk
    Research funding from: AstraZeneca; Fresenius Medical Care


  • Rita Moreira Da Silva, PhD, PharmD

    Medical Education Director, WebMD Global, LLC


    Rita Moreira Da Silva, PhD, PharmD, has no relevant financial relationships.

  • Gina Montanero, PharmD

    Associate Medical Writer, Medscape, LLC


    Gina Montanero, PharmD, has no relevant financial relationships.

Compliance Reviewer

  • Yaisanet Oyola, MD

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Yaisanet Oyola, MD, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.

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    For Physicians

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Real-Life Cases of Patients With Type 2 Diabetes and Chronic Kidney Disease: A Practice Challenge

Authors: Roberto Pecoits-Filho, MD, PhDFaculty and Disclosures

CME Released: 2/24/2023

Valid for credit through: 2/24/2024, 11:59 PM EST


The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.


Mira is a 63-year-old woman of Asian descent with type 2 diabetes (T2D) diagnosed 12 years ago. She comes into her primary care physician (PCP) for her yearly visit. Her glycated hemoglobin (HbA1c) is 7.4% while taking the maximum dose of metformin and glyburide. She also has osteoarthritis and controlled hypertension on angiotensin receptor blocker (ARB) therapy.

You note that her estimated glomerular filtration rate is (eGFR) is 35 mL/min/1.73 m2 and her serum potassium level is 4.1 mmol/L. Mira's medical history and results of her physical exam and laboratory tests are shown in Table 1.

Table 1. Mira's Medical Record

History Findings
Medical T2D × 12 years, osteoarthritis, hypertension
Current medications Metformin 1000 mg/d, glyburide 20 mg/d, losartan 100 mg/d, atorvastatin 10 mg/d
Social/occupational Married, lives with husband and dog; non-drinker; has 2 adult daughters in college
Physical exam Findings
Vital signs BP: 120/80 mm Hg
Heart rate: 78 bpm
Body measurements BMI: 25.5 kg/m2
Extremities No edema
Neck No distended neck veins
Heart Echo: presence of LVH, LVEF: 60%, BNP: 90 pg/mL
Lungs No rales
Abdomen Soft, nontender
CBC Results
Metabolic panel Results
HbA1c 7.4%
Lipid panel LDL: 65 mg/Dl; HDL: 41 mg/Dl, TG: 145 mg/Dl
SrCr 1.55 mg/Dl
eGFR 35 mL/min/1.73 m2
Serum potassium 4.1 mmol/L
BMI, body mass index; BP, blood pressure; bpm, beats per minute; BNP, brain natriuretic peptide; CBC, complete blood count; Echo, echocardiogram; HDL, high-density lipoprotein; LDL, low-density lipoprotein; LVEF, left ventricular ejection fraction; LVH, left ventricular hypertrophy; SrCr, serum creatinine; TG, triglyceride.
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