How to Work with Your Healthcare Team to Manage Diabetes-related Kidney Disease

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Managing diabetes-related kidney disease, also known as diabetic kidney disease (DKD) or diabetic nephropathy, requires a comprehensive, coordinated approach involving multiple healthcare professionals working together with you as the central member of the team. Diabetes mellitus is the most common cause of chronic kidney disease leading to kidney failure and premature death. Understanding how to effectively collaborate with your healthcare team can significantly improve your health outcomes, slow disease progression, and enhance your quality of life.

Diabetic kidney disease is a type of kidney disease caused by diabetes. Diabetes is the leading cause of kidney disease. About 1 out of 3 adults with diabetes has kidney disease. This serious complication develops when high blood glucose levels damage the blood vessels in your kidneys over time, affecting their ability to filter waste and excess fluid from your blood.

High blood glucose, also called blood sugar, can damage the blood vessels in your kidneys. When the blood vessels are damaged, they don’t work as well. Many people with diabetes also develop high blood pressure, which can also damage your kidneys. The condition typically develops slowly over many years, often without noticeable symptoms in the early stages, making regular screening and proactive management essential.

Diabetic kidney disease (DKD) represents the predominant and severe microvascular complication associated with diabetes, frequently culminating in End-Stage Kidney Disease (ESKD). The escalating prevalence of diabetes has correspondingly led to a rise in DKD incidence, imposing significant challenges on both individuals and society. This underscores the critical importance of working closely with your healthcare team to implement evidence-based strategies that can prevent or delay disease progression.

Building Your Comprehensive Healthcare Team

Effective management of diabetes-related kidney disease requires a multidisciplinary approach. Optimal management of CKD in diabetes is a complex, multidisciplinary, cross-functional team effort. Your healthcare team should include various specialists, each bringing unique expertise to address different aspects of your condition.

Primary Care Provider

Your primary care provider (PCP)—doctor, nurse practitioner, or physician assistant—is the person you see for routine medical visits. Your PCP may monitor your kidney health and help you manage your diabetes and high blood pressure. Your primary care provider often serves as the coordinator of your overall care, ensuring that all team members communicate effectively and that your treatment plan remains cohesive.

Nephrologist

Nephrologists are doctors who have advanced training in treating kidney disease. A nephrologist specializes in kidney health and becomes increasingly important as your kidney disease progresses. An active urinary sediment (containing red or white blood cells or cellular casts), rapidly increasing albuminuria or total proteinuria, the presence of nephrotic syndrome, rapidly decreasing eGFR, or the absence of retinopathy (particularly in type 1 diabetes) suggests alternative or additional causes of kidney disease. For individuals with these features, referral to a nephrologist for further diagnosis, including the possibility of kidney biopsy, should be considered.

Endocrinologist

An endocrinologist specializes in hormone-related conditions, including diabetes. This specialist can help optimize your blood glucose control through medication adjustments, insulin management, and advanced diabetes technologies. It bridges from diabetes management in general practice or diabetology settings to CKD management in the nephrology setting. Working with an endocrinologist ensures that your diabetes treatment plan is tailored to protect your kidney function while maintaining appropriate glucose levels.

Registered Dietitian Nutritionist

A registered dietitian nutritionist with expertise in kidney disease and diabetes plays a crucial role in your care team. Team-based integrated care, supported by decision-makers, should be delivered by physicians and nonphysician personnel (e.g., trained nurses and dieticians, pharmacists, healthcare assistants, community workers, and peer supporters) preferably with knowledge of CKD. They can help you develop meal plans that manage blood glucose levels, control blood pressure, reduce protein intake if necessary, and address other nutritional concerns specific to kidney disease.

Clinical Pharmacist

Some healthcare teams include a clinical pharmacist who makes sure medicines are given in the correct amount and at the correct time. Due to the complex nature of diabetes and CKD management, a holistic, patient-centered, collaborative care approach delivered by a coordinated multidisciplinary team (ideally including a clinical pharmacist as part of a comprehensive medication management program) is needed. A clinical pharmacist can review your medications for potential interactions, ensure proper dosing based on your kidney function, and help you understand how and when to take your medications.

Diabetes Educator

A certified diabetes care and education specialist can teach you essential self-management skills, including blood glucose monitoring, medication administration, recognizing symptoms of complications, and making lifestyle modifications. They provide ongoing education and support to help you navigate the complexities of managing both diabetes and kidney disease.

Nephrology Nurse

A nurse may help with your treatment and teach you about monitoring and treating kidney disease, as well as managing your health conditions. Nephrology nurses provide direct patient care, education about kidney disease management, and support throughout your treatment journey. They often serve as a key point of contact for questions and concerns between appointments.

Social Worker

Nephrology social workers provide counseling to help patients and their families cope with kidney disease and changes in the family, home, workplace and community. They help patients plan treatment to fit their lifestyle and activities. They identify sources of emotional support for patients who need it. They also identify services within federal, state and community agencies to meet patients’ needs and help patients and families access services when necessary.

Additional Specialists

Since multi-morbidity is common among people with diabetes and CKD, care usually involves many other specialties, including but not limited to ophthalmology, neurology, orthopedic surgery, and cardiology. Depending on your individual needs, your team may also include cardiologists to manage heart health, ophthalmologists to monitor diabetic eye disease, podiatrists for foot care, and mental health professionals to address the emotional aspects of living with chronic conditions.

The Importance of Team-Based Care

Multidisciplinary integrated care for patients with diabetes and CKD would represent a good investment. A team-based, integrated approach includes regular assessment, control of multiple risk factors, and self-management to protect kidney function and reduce risk for complications. Research consistently demonstrates that coordinated, multidisciplinary care leads to better outcomes for patients with diabetes and kidney disease.

Team-based chronic care models that focus on treatment to multiple targets and self-management are cost-effective and cost-saving and are likely to achieve multiple treatment targets and improve clinical outcomes. This approach ensures that all aspects of your health are addressed comprehensively, with team members communicating regularly to adjust your treatment plan as needed.

Health care systems should include team-based care for patients and focus on both short- and long-term treatment plans. Lifestyle interventions for the patient must be included in determining an overall plan of care to ensure individual preferences are addressed and goals are established by all team members, especially the patient. You are the most important member of this team, and your preferences, goals, and daily experiences should guide all treatment decisions.

Establishing Effective Communication with Your Healthcare Team

Open, honest, and consistent communication forms the foundation of successful diabetes and kidney disease management. Effective communication ensures that your healthcare team understands your concerns, challenges, and goals, while you gain the knowledge and confidence needed to manage your condition effectively.

Be Honest and Transparent

Share complete and accurate information with your healthcare team about your symptoms, lifestyle habits, medication adherence, and any challenges you face in following your treatment plan. If you’re experiencing side effects from medications, struggling with dietary restrictions, or finding it difficult to monitor your blood glucose regularly, let your team know. They can only help you effectively if they understand the full picture of your health and daily life.

Ask Questions

You and your family should not be afraid to ask questions. Each and every person on the health care team is there to help you feel your best. No question is too small or insignificant. If you don’t understand something about your condition, treatment plan, or test results, ask for clarification. Request that information be explained in terms you can understand, and don’t hesitate to ask the same question multiple times if needed.

Share Your Goals and Preferences

Communicate your personal health goals, lifestyle preferences, and concerns about treatment options. Your healthcare team needs to understand what matters most to you—whether it’s maintaining your ability to work, participating in specific activities, minimizing medication burden, or other priorities. This information helps them tailor recommendations to fit your life and values.

Report Changes Promptly

Contact your healthcare team promptly when you notice new symptoms, changes in your condition, or unexpected results from home monitoring. Early intervention can often prevent complications or adjust treatment before problems become more serious. Don’t wait until your next scheduled appointment to report concerning changes.

Facilitate Team Communication

Care coordination involves organizing patient care activities and efficiently communicating patient care information between all members of the patient’s care team, with the ultimate goal of achieving safer and more effective care for the patient. Effective care coordination focuses on the total healthcare needs of the patient. Help your healthcare providers communicate with each other by ensuring they all have current contact information for your other providers, signing necessary release forms, and sharing test results or recommendations from one provider with others on your team.

Preparing for Healthcare Appointments

Thorough preparation for appointments ensures productive visits and helps your healthcare team make informed decisions about your care. Well-prepared appointments maximize the limited time you have with each provider and ensure that important topics aren’t overlooked.

Keep Detailed Records

Maintain organized records of your blood glucose readings, blood pressure measurements, weight, symptoms, and any other health information your team has asked you to track. Many patients find it helpful to use apps, spreadsheets, or paper logs to record this information. Bring these records to every appointment so your providers can identify patterns and trends.

Create a Medication List

Keep an up-to-date list of all medications you take, including prescription drugs, over-the-counter medications, vitamins, and supplements. Include the name, dosage, frequency, and reason for each medication. Bring this list to every appointment and update it whenever changes are made. This helps prevent dangerous drug interactions and ensures all providers know what you’re taking.

Prepare Your Questions

Write down questions and concerns before your appointment. Prioritize your list, putting the most important items first in case time runs short. Consider questions about test results, medication changes, symptom management, lifestyle modifications, and any new treatments or clinical trials that might be appropriate for you.

Document Symptoms

Keep a symptom diary noting when symptoms occur, their severity, duration, and any factors that seem to trigger or relieve them. This detailed information helps your healthcare team understand patterns and make more accurate diagnoses and treatment adjustments.

Bring Support

A trusted friend or family member can take notes, ask questions you may not have thought of, offer support, and help remember what the provider said during the visit. Talk ahead of time about what you want to get out of the visit and the role you would like your friend or relative to play. Having someone with you can help you remember important information and provide emotional support during difficult discussions.

Review Previous Visit Notes

Before each appointment, review notes from your previous visit and any instructions or recommendations you received. This helps ensure continuity of care and allows you to report on how well you’ve been able to follow previous recommendations or any challenges you’ve encountered.

Understanding and Following Your Treatment Plan

Adhering to your prescribed treatment plan is essential for slowing the progression of kidney disease and preventing complications. Substantial evidence indicates that early, aggressive treatment can delay or prevent the progression of the disorder. Your treatment plan will likely include multiple components that work together to protect your kidney function and overall health.

Medication Management

Take all prescribed medications exactly as directed. Medicines that lower blood pressure can also help slow kidney damage. Two types of blood pressure medicines, ACE inhibitors and ARBs, play a special role in protecting your kidneys. Each has been found to slow kidney damage in people with diabetes who have high blood pressure and DKD.

Recent advances in treatment have introduced new medication classes that provide significant kidney protection. It was stopped early due to positive efficacy and showed a 32% risk reduction for development of ESKD over control. SGLT2 inhibitors, a class of diabetes medications, have shown remarkable benefits for kidney health. In January 2025, the FDA approved an injectable form of semaglutide (Ozempic), a GLP1-RA, to treat chronic kidney disease (CKD) in people with type 2 diabetes. Approval of this medicine is significant for those with CKD and type 2 diabetes, as it offers additional support to manage both conditions.

Among patients with T2DM and moderate albuminuria (urinary albumin creatinine ratio UACR ≥ 30 mg/g), the three-drug combination of SGLT2i, GLP-1 RA, and ns-MRA resulted in a significant reduction in the risk of cardiovascular and kidney events, as well as an improvement in overall survival when compared to conventional treatment methods. This highlights the importance of combination therapy approaches in managing diabetic kidney disease.

Blood Glucose Control

The best way to slow or prevent diabetes-related kidney disease is to try to reach your blood glucose and blood pressure goals. Healthy lifestyle habits and taking your medicines as prescribed can help you achieve these goals and improve your health overall. Monitor your blood glucose levels as recommended by your healthcare team and use the results to guide decisions about food, physical activity, and medications.

Your health care provider will also test your A1C. The A1C is a blood test that measures your average blood glucose level over the past 3 months. The A1C goal for many people with diabetes is below 7 percent. Ask your health care team what your goal should be. Reaching your goal numbers will help you protect your kidneys. However, your individual target may differ based on your specific circumstances, including the stage of your kidney disease, other health conditions, and risk of hypoglycemia.

Blood Pressure Management

The most important step you can take to treat kidney disease is to control your blood pressure. Your health care team will also work with you to help you set and reach your blood pressure goal. The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Ask your health care team what your goal should be. Monitor your blood pressure regularly at home if recommended, and report any consistently elevated readings to your healthcare team.

Dietary Modifications

Follow the dietary recommendations provided by your registered dietitian nutritionist. Your diet plan will likely address multiple goals, including blood glucose control, blood pressure management, appropriate protein intake, sodium restriction, and management of other nutrients like potassium and phosphorus as your kidney disease progresses. Work closely with your dietitian to develop meal plans that are both nutritionally appropriate and realistic for your lifestyle and preferences.

Physical Activity

Engage in regular physical activity as recommended by your healthcare team. Exercise helps control blood glucose levels, manage blood pressure, maintain a healthy weight, and improve overall cardiovascular health. Discuss appropriate types and amounts of exercise with your providers, especially if you have other diabetes complications or health concerns that might affect your ability to exercise safely.

Lifestyle Modifications

Additional lifestyle changes may include quitting smoking, limiting alcohol consumption, managing stress, and getting adequate sleep. Each of these factors can affect both diabetes control and kidney health. Your healthcare team can provide resources and support to help you make and maintain these important lifestyle changes.

Regular Monitoring and Screening

Consistent monitoring allows your healthcare team to track disease progression, assess treatment effectiveness, and make timely adjustments to your care plan. Both the ADA and KDIGO recommend annual screening of patients with diabetes for CKD. Understanding what tests you need and why they’re important helps you stay engaged in your care.

Kidney Function Tests

Annual or risk-based measurement of eGFR and uACR, confirmation of abnormal uACR on repeat testing, and risk categorization using the eGFR×uACR heat map and KFRE. Your healthcare team will regularly check your estimated glomerular filtration rate (eGFR), which measures how well your kidneys are filtering blood, and your urine albumin-to-creatinine ratio (uACR), which detects protein in your urine—an early sign of kidney damage.

Blood Glucose Monitoring

Regular blood glucose monitoring, both through self-monitoring at home and periodic A1C testing, provides essential information about your diabetes control. To reach your blood glucose goal, check your blood glucose level regularly. Use the results to guide decisions about food, physical activity, and medicines. Ask your health care provider how often you should check your blood glucose level. The frequency of monitoring will depend on your treatment plan, type of diabetes medications, and how well controlled your blood glucose levels are.

Blood Pressure Monitoring

Regular blood pressure checks, both at healthcare visits and at home if recommended, help ensure that your blood pressure remains within target range. High blood pressure accelerates kidney damage, making consistent monitoring and control essential for protecting your kidney function.

Additional Laboratory Tests

Your healthcare team may order additional tests to monitor for complications and assess overall health, including lipid panels to check cholesterol levels, complete blood counts to check for anemia, electrolyte panels to monitor potassium and other minerals, and tests for vitamin D and parathyroid hormone levels as kidney disease progresses.

Screening for Complications

Regular screening for other diabetes complications is important, as these conditions often occur together. This includes annual eye exams to check for diabetic retinopathy, foot exams to detect neuropathy and circulation problems, and cardiovascular assessments since people with diabetes and kidney disease have significantly increased risk for heart disease.

Overcoming Barriers to Effective Care

Barriers such as low CKD awareness, high complexity of care, difficulties with adhering to increasingly complex treatment regimens, and low recognition and application of guideline-directed management all contribute to suboptimal management of patients with diabetes and CKD. Recognizing and addressing these barriers is essential for successful disease management.

Addressing Treatment Complexity

Managing diabetes and kidney disease often involves multiple medications, dietary restrictions, monitoring requirements, and lifestyle modifications. This complexity can feel overwhelming. Work with your healthcare team to simplify your regimen where possible, use pill organizers or medication reminder apps, and break large goals into smaller, manageable steps. Don’t hesitate to ask for help when you’re feeling overwhelmed by the complexity of your treatment plan.

Improving Health Literacy

Understanding your condition and treatment plan is crucial for effective self-management. If medical terminology or concepts are confusing, ask your healthcare team to explain things in simpler terms, provide written materials, or recommend reliable educational resources. Many healthcare systems offer patient education programs specifically designed for people with diabetes and kidney disease.

Managing Financial Concerns

The cost of managing diabetes and kidney disease can be substantial, including medications, supplies, appointments, and laboratory tests. Discuss financial concerns openly with your healthcare team and social worker. They can help you identify assistance programs, generic medication alternatives, and community resources that may help reduce costs. Never skip medications or appointments due to cost without first discussing alternatives with your healthcare team.

Addressing Emotional and Mental Health

Depression is common among people with a chronic, or long-term, illness. Depression can make it harder to manage your kidney disease. Ask for help if you feel down. Seek help from a mental health professional. Talking with a support group, clergy member, friend, or family member who will listen to your feelings may help. Mental health is an integral part of managing chronic disease, and addressing emotional challenges can significantly improve your ability to follow your treatment plan.

Without effective care coordination, there is a risk of delivering fragmented and duplicative patient care, which can result in unnecessary additional healthcare costs. If you’re experiencing difficulties with appointment scheduling, communication between providers, or accessing services, speak with your social worker or patient advocate. They can help navigate system complexities and ensure you receive coordinated, efficient care.

Self-Management Strategies

You and your family are the most important members of the health care team. You can take an active role in your care by learning all you can and cooperating fully with your treatment plan. Effective self-management is essential for successful outcomes in diabetes-related kidney disease.

Develop Organizational Systems

Create systems to help you stay organized and on track with your treatment plan. This might include using smartphone apps to track medications and appointments, setting alarms for medication times, keeping a health binder with all your medical information, and maintaining a calendar specifically for healthcare-related tasks and appointments.

Build a Support Network

Connect with family members, friends, support groups, and online communities of people managing similar conditions. Support from others who understand your challenges can provide emotional encouragement, practical tips, and motivation to stay committed to your treatment plan. Many hospitals and community organizations offer support groups specifically for people with diabetes and kidney disease.

Stay Informed

Continue learning about diabetes and kidney disease through reputable sources. Understanding your condition empowers you to make informed decisions, recognize warning signs of complications, and have more productive conversations with your healthcare team. Ask your providers to recommend reliable educational resources, including websites, books, and patient education programs.

Practice Problem-Solving

When you encounter obstacles to following your treatment plan, use problem-solving strategies rather than giving up. Identify the specific barrier, brainstorm possible solutions, choose one to try, implement it, and evaluate the results. Discuss challenges with your healthcare team—they can often suggest solutions you haven’t considered.

Set Realistic Goals

Work with your healthcare team to set specific, measurable, achievable, relevant, and time-bound (SMART) goals. Start with small, manageable changes rather than trying to overhaul your entire lifestyle at once. Celebrate successes along the way, and don’t be discouraged by setbacks—they’re a normal part of managing chronic disease.

Staying Current with Treatment Advances

The field of diabetes and kidney disease management is rapidly evolving, with new treatments and approaches emerging regularly. Recent advancements in novel therapeutics, stem cell therapies, and related fields provide promising new avenues for treatment. Staying informed about new developments and discussing them with your healthcare team can ensure you have access to the most effective treatments.

Emerging Medications

New medications continue to be developed and approved for diabetes and kidney disease management. SGLT-2 inhibitor therapy should be carried out for as long as possible if tolerated, and should be continued even if eGFR falls below 20mL (/ min•1.73m2) until kidney replacement therapy is started. Ask your healthcare team about new treatment options that might be appropriate for you, and whether you might be eligible for clinical trials investigating promising new therapies.

Advanced Monitoring Technologies

A smartphone-enabled albuminuria (or proteinuria) test allowed people with hypertension or diabetes screen for kidney disease at home. The results of the study showed that this was a great way to increase screening for albuminuria (protein in the urine) in these at-risk populations, with 53% of the people with access to the at-home test completing an albuminuria test versus 21% in the group that did not have the at-home test. This could be an effective way to increase screening and early intervention for kidney disease in high-risk populations.

Personalized Medicine Approaches

The integration of traditional clinical markers, digital TCM-derived phenotypes, and multi-omics data represents a promising paradigm for early, personalized, and dynamic DKD care. Advances in understanding the genetic and molecular basis of kidney disease are leading to more personalized treatment approaches. Discuss with your healthcare team whether any emerging personalized medicine strategies might be appropriate for your situation.

Planning for Disease Progression

While the goal is always to slow or prevent disease progression, it’s important to have open discussions with your healthcare team about what to expect as kidney disease advances and what treatment options might be needed in the future. Early planning allows you to make informed decisions and prepare emotionally and practically for potential changes in your care.

Understanding Disease Stages

Learn about the different stages of chronic kidney disease and what each stage means for your treatment and prognosis. Understanding the trajectory of the disease helps you know what to expect and when certain interventions might become necessary. Your healthcare team can explain which stage you’re currently in and what factors influence progression.

Discussing Future Treatment Options

If kidney disease progresses to advanced stages, you may eventually need kidney replacement therapy. Have early discussions with your nephrologist about the different options, including hemodialysis, peritoneal dialysis, and kidney transplantation. Understanding these options well before they’re needed allows you to make informed decisions and prepare appropriately.

Advance Care Planning

Discuss your values, preferences, and goals for care with your healthcare team and loved ones. Advance care planning ensures that your wishes are known and respected if you become unable to make decisions for yourself. This includes completing advance directives and discussing what quality of life means to you.

Key Action Steps for Working with Your Healthcare Team

To maximize the effectiveness of your collaboration with your healthcare team, focus on these essential action steps:

  • Attend all scheduled appointments and arrive prepared with questions, symptom records, and updated medication lists
  • Monitor and record your blood glucose levels, blood pressure, weight, and symptoms as recommended by your healthcare team
  • Take medications exactly as prescribed and report any side effects or difficulties with adherence promptly
  • Follow dietary recommendations provided by your registered dietitian nutritionist and ask for help if you’re struggling to maintain the diet
  • Engage in regular physical activity appropriate for your health status and abilities
  • Communicate openly and honestly with all members of your healthcare team about challenges, concerns, and changes in your condition
  • Ask questions whenever you don’t understand something about your condition or treatment plan
  • Facilitate communication between your various healthcare providers to ensure coordinated care
  • Stay informed about your condition through reliable educational resources recommended by your healthcare team
  • Build a support network of family, friends, and others managing similar conditions
  • Address mental health needs and seek support when feeling overwhelmed or depressed
  • Discuss new treatment options and advances in care with your healthcare team regularly
  • Plan ahead for potential disease progression and future treatment needs
  • Advocate for yourself and speak up if you feel your concerns aren’t being addressed or if you need additional support

Resources and Support

Numerous organizations provide valuable resources, education, and support for people managing diabetes-related kidney disease. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) offers comprehensive, evidence-based information about diabetes and kidney disease management. The National Kidney Foundation provides educational materials, support programs, and advocacy for people with kidney disease. The American Diabetes Association offers resources specifically for diabetes management and complications. The American Kidney Fund provides financial assistance programs and educational resources. Additionally, Kidney Disease: Improving Global Outcomes (KDIGO) publishes clinical practice guidelines that inform evidence-based care worldwide.

Many hospitals and healthcare systems also offer patient education programs, support groups, and disease management programs specifically designed for people with diabetes and kidney disease. Ask your healthcare team about local resources available in your community.

Conclusion

Successfully managing diabetes-related kidney disease requires a collaborative partnership between you and a multidisciplinary healthcare team. Proposed strategies that may contribute to improved management of patients with diabetes and CKD include implementation of multidisciplinary models of care, structured risk mitigation strategies and education, multidisciplinary educational initiatives, harmonization of clinical practice guidelines, and provision of self-management programs for patients with diabetes and CKD. By building a comprehensive healthcare team, communicating effectively, preparing thoroughly for appointments, following your treatment plan, staying informed about advances in care, and actively participating in your own health management, you can significantly improve your outcomes and quality of life.

Remember that you are the most important member of your healthcare team. Your daily choices, commitment to treatment, and willingness to communicate openly with your providers directly impact your health outcomes. While managing diabetes and kidney disease presents challenges, with the right team, knowledge, and support, you can take control of your health and work toward the best possible outcomes. Stay engaged, ask questions, advocate for your needs, and never hesitate to reach out to your healthcare team when you need guidance or support. Together, you and your healthcare team can navigate the complexities of diabetes-related kidney disease and work toward preserving your kidney function and overall health for years to come.