Individualised HbA1c Target CKD — ESENeph MCQ

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ModerateChronic Kidney DiseaseIndividualised HbA1c Target CKDESENeph

A 50-year-old man with CKD G4 and type 2 diabetes is found to have haemoglobin A1c of 42 mmol/mol and fasting glucose consistently 4.5-5.5 mmol/L while on Metformin and Dapagliflozin. He is considered to have achieved glycaemic targets. What does KDIGO 2024 recommend as the individualised HbA1c target in CKD?

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Correct answer: D — An individualised target generally <48 mmol/mol (<53 mmol/mol for some) – with emphasis that targets should not be so aggressive as to cause hypoglycaemia, particularly in advanced CKD where hypoglycaemia risk is increased

KDIGO 2022 diabetes in CKD guideline recommends an individualised HbA1c target, generally around <48 mmol/mol for most patients, but with flexibility (<53 mmol/mol) for those at risk of hypoglycaemia (advanced CKD, elderly, comorbid). In CKD G4-5, hypoglycaemia risk is increased due to reduced renal gluconeogenesis, reduced insulin clearance, and impaired counter-regulatory responses. Overly aggressive glycaemic control in advanced CKD increases hypoglycaemia, which is associated with increased mortality. The target should balance glycaemic control against hypoglycaemia risk.

Reference: KDIGO 2022 – Diabetes Management in CKD; KDIGO 2024 – CKD