Glycemic control is essential to delay or possibly prevent the development of diabetic nephropathy. There are multiple glucose-lowering medications now available to help attain goal glycemic control but only some of them can be used safely in chronic kidney disease and others can be used safely with dose reductions. An ideal target for therapy is a hemoglobin A1c of approximately 7 % to minimize microvascular complications. However, achieving an A1c of 7 % can be difficult; it requires vigilance on the part of the patient and physician and is accompanied by higher rates of hypoglycemia.
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