With the improvement of our national living standard, diabetes is “growing out of control” in China. At present, the number of diabetic patients in China is 114 million, 22 million more than five years ago, with an average annual increase of 5.5 million cases, 15,000 cases per day, 600 cases per hour, and 10 cases per minute. The main reason for this current situation is that the lifestyle of the general public is closely related. High salt intake, obesity, and sedentary lifestyle are all important factors that cause the onset of diabetes. The effect of diabetes on all organs of the body is systemic, progressive and irreversible. Diabetes damage to the body is mainly concentrated in the large and small blood vessels, causing vascular thickening to occlusion. The kidneys are the most vascularized organ in the body, and about 40% of diabetes is combined with kidney damage. The core of diabetes prevention and kidney protection lies in the scientific management of one’s lifestyle. This article will help you to improve your understanding of diabetes and diabetic kidney prevention and treatment. The incidence of diabetes is increasing every year and about 40% of diabetic patients will develop chronic kidney disease (CKD). Diabetes has become the leading cause of end-stage kidney disease (ESKD) in developed countries. In February 2015, KDIGO organized experts from around the world to develop guidelines for the management of patients with diabetic CKD. In this article, we will share the main contents with you. Lifestyle Salt intake, obesity, and sedentary lifestyle are associated with the incidence of diabetic kidney disease (DKD) and mortality. Restricting salt intake can reduce blood pressure and urinary protein, and may increase the efficacy of renin angiotensin system inhibitors (RASi). The optimal daily salt intake for patients with DKD is still controversial. Meanwhile, weight loss, exercise, and supplementation with mono- or polyunsaturated fatty acids are beneficial in controlling blood glucose, blood pressure, and urinary protein. Glucose control The prognosis of renal disease with intensive glucose control remains controversial. Glucose lowering drugs Low-dose metformin (≤1g/day) can be used in people with stable renal function; it can also be used in people with eGFR <30mL/min/1.73m2, but safety is controversial. GLP-1 receptor agonists, DDP-4 inhibitors and SGLT2 inhibitors all have renoprotective effects independent of glucose-lowering effects. Blood glucose monitoring The current long-term glucose monitoring index HbA1c in diabetic patients is controversial in the use of CKD patients. Glycated albumin, glycosamine or 1,5-anhydroglucitol may be alternative indicators. Hypoglycemia Hypoglycemia is associated with increased mortality in CKD patients. Dual RAS blockade Dual RAS blockade therapy significantly increases the incidence of adverse effects such as hyperkalemia and acute kidney damage. Cardiovascular outcomes Patients with DKD are at significantly increased risk of cardiovascular disease (CVD). Blood pressure and dyslipidemia are the main traditional risk factors for CVD. kDIGO updated guidelines for blood pressure and lipid management: Patients with diabetes and proteinuria (urinary albumin/creatinine ratio >3 mg/mmol or >30 mg/g) are given single-dose RAS blockers to control blood pressure to <130/80 mmHg in combination with medium-dose statins. Volume control Increased insulin, RASi, SGLT2 co-transferrin activity and decreased GFR are the main factors contributing to water and sodium retention in patients. However, the effect of volume overload on the incidence of CVD and mortality is not known. Lipid control Lipid-lowering drugs can safely reduce CVD events in patients with CKD. Guidelines recommend: medium-dose statins without dose adjustment. Further research is needed to target lipoprotein abnormalities, low HDL cholesterol and high triglycerides. Antiplatelet/thrombotic therapy The use of antiplatelet and antithrombotic agents for CVD prevention in patients with DKD or CKD has not been adequately studied. Given the risks associated with the use of antiplatelet/anti-thrombotic agents, it is critical to clarify when to apply such agents and which patients should be treated with them. Atrial fibrillation is a common condition in patients with CKD and dialysis, but treatment with warfarin may increase the risk of bleeding, vascular calcification, and calcified defenses. Safety In patients with diabetic CKD, there is an increased risk of adverse drug reactions; therefore, drug safety should be a concern when taking glucose-lowering drugs for glycemic control.