Diabetic kidney disease (DKD) management is a rapidly evolving field. Alongside risk prediction tools, such as the Kidney Failure Risk Equation, there is greater emphasis on person-centred care and education. For people with type 2 diabetes (T2DM), sodium-glucose cotransporter 2 inhibitors (SGLTi) and finerenone have joined the five previous pillars of care which are foundations for both type 1 diabetes (T1DM) and T2DM. These include blood glucose optimisation, blood pressure management, renin–angiotensin–aldosterone system inhibitors (RAASi), lipid management and smoking cessation. The evolution of hyperkalaemia management, due to the availability of potassium binders, has enabled the optimal use of RAASi. Ongoing studies in people with T1DM will further inform DKD management in the future.
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