Best Approach to Prevent Diabetic Nephropathy

The last two decades have witnessed a storm in our understanding of the pathogenesis of diabetic nephropathy. In parallel, the newly evolved hypoglycemic agents have shown different mechanisms of action that would effectively tackle the different pathogenic mechanisms involved in the development and progression of diabetic nephropathy. Several large prospective placebo controlled clinical trials have supported the significant impact of these different agents to withhold the progression of diabetic nephropathy. Almost all these trials involved type 2 diabetes mellitus (T2DM). However, most of these agents can additionally be used in type1 diabetes mellitus (T1DM) patients aiming at avoidance of long-term complications of this disease. The most recent of these trial, the DECLARE - TIMI 58 renal outcome trial, have additionally declared the preventive value of dapagliflozin in T2DM. In this review, we are going to discuss the most recent and relevant pathogenic mechanisms highlight the therapeutic and value of the early use of the different agents to prevent the development of diabetic nephropathy.