At present, the prevalence of diabetes in adults in China is 11.6%, most of which are type 2 diabetes. Some studies show that type 2 diabetes combined with chronic kidney disease reaches 40%, and among patients on uremic dialysis, 20% are caused by diabetes. For diabetes combined with chronic nephropathy how to lower blood sugar? How to slow down the progression of nephropathy? This is a problem that every diabetic doctor needs to consider clinically, and it is also of great concern to diabetic patients. I will elaborate on this aspect for the reference of doctors and patients by combining the views of the latest experts as follows. 1.When to adjust the treatment plan Diabetic nephropathy patients from the initial microalbuminuria, to dominant proteinuria, to massive proteinuria, and then renal decompensation and uremia, when should we adjust the ongoing treatment plan? About the appearance of urine protein does not affect the glucose-lowering treatment, but if the glomerular filtration rate (GFR) decreases, due to the beginning of this time, there are changes in drug excretion through the kidneys, it is necessary to consider the change of treatment plan. 2.Control of blood sugar, blood pressure and urine protein Strict control of blood sugar, blood pressure and urine protein can not only reduce the occurrence of end-stage renal disease, but also slow down the progress of renal disease. Blood sugar: fasting blood sugar <6.1 mmol/L, postprandial blood sugar <8.0 mmol/L; blood pressure: for those with 24-hour urine protein <1.0g, control blood pressure <130/80mmHg, for those with 24-hour urine protein >1.0g, control blood pressure <125/75mmHg, with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor antagonist ( ARB) can well lower blood pressure, and also reduce the amount of urine protein, reduce intra-glomerular pressure, and favorably protect the kidney. And pioglitazone can increase insulin sensitivity, reduce weight, reduce protein leakage and delay the progress of kidney disease. 3, the choice of hypoglycemic drugs (1) Metformin Metformin itself does not lead to kidney damage, when the patient combined with other serious conditions, metformin should be discontinued and restarted under the guidance of a specialist. Because of its potential to induce lactic acidosis, it should be discontinued when GFR reaches 30 ml/min/1.73 m2. (2) Pioglitazone Pioglitazone is excreted mainly as prodrug and its metabolites into the bile, but if hepatic insufficiency occurs, 15-30% of the prodrug will be excreted in the urine, otherwise no dose adjustment is necessary, and it can be used safely in patients with reduced renal function and in the elderly. However, if fluid retention occurs, continued use is not advisable. (3) Repaglinide Repaglinide is mainly metabolized by the liver and less than 8% is excreted through urine. The active metabolites do not increase with declining renal function, and no dose adjustment is required in the case of declining renal function. However, be alert to the risk of hypoglycemia. This is clearly stated in the recent Expert Consensus on the Principles of Application of Oral Hypoglycemic Agents in Patients with Type 2 Diabetes Mellitus Combined with Chronic Kidney Disease. Some experts believe that Repaglinide can be safely applied throughout the course of chronic kidney disease without serious adverse effects. (4) DPP-4 inhibitors Generally speaking, such drugs require dose adjustment in patients with reduced GFR when chronic kidney disease progresses from stage 3 to stage 4, but no adjustment is needed for liglitazepam. (5) Insulin Exogenous insulin is mainly cleared by the kidneys, and its dose needs to be adjusted as renal function decreases to avoid hypoglycemia. Note: The above are only the views of some experts and individuals. Patients or doctors are advised to refer to the latest drug instructions and the latest research progress when using the drugs clinically.