Sodium-Glucose Cotransporter-Inhibitors, Incretin Receptor Agonists (Glucagon-Like Peptide-1 Receptor Agonists and Dual Glucose-Dependent Insulinotropic Polypeptide/Glucagon-Like Peptide-1 Receptor Agonists), and Finerenone for Kidney Protection in Type 1 Diabetes.
Diabetes-related kidney disease (DKD) is a major complication of type 1 diabetes (T1D) and remains a leading cause of kidney failure and cardiovascular risk. In this article, we summarize the biologic rationale and emerging clinical evidence for adjunctive kidney-protective therapies in T1D. We frame DKD pathophysiology in T1D around 3 interrelated domains: hyperglycemia-driven kidney stress, maladaptive tubular-glomerular hemodynamics and hyperfiltration, and inflammatory and fibrotic injury amplified by mineralocorticoid receptor signaling. The rapid growth in mechanistic understanding, clinical trial evidence, and early translation to T1D supports the incorporation of adjunctive kidney-protective therapies into the future management of DKD in T1D.