End-stage renal failure is a common sequelae of type 2 diabetes. ACEI and ARBs are the drugs routinely used for renal protection in diabetes.
Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a newer class of hypoglycaemic agents that lowers blood glucose in patients with type 2 diabetes by increasing the urinary glucose excretion through the inhibition of SGLT2 in the proximal convoluted tubule where the glucose is reabsorbed. SGLT2 inhibitors reduce the renal threshold of glucose from 180 mg per deciliter (10 mmol per liter) to 40 to 120 mg per deciliter (2 to 7 mmol per liter), thereby effectively lowering blood glucose levels.
The CREDENCE trial [Ref] showed that SGLT2 inhibitors in combination with ACEI and ARBs reduce cardiovascular events and renal disease in patients with type 2 diabetes and renal impairment. The NEJM 2019 original article that reported the CREDENCE trial is available at this LINK
A quick take video by the NEJM explains the CREDENCE trial in less than two minutes. [LINK]
BMJ Evidence-Based Medicine journal delivers the verdict in plain language summarizing the full-text article to one page.bmjebm-2019-111231.full
An editorial in the NEJM published with the CREDENCE trial is given below.nejme1904740