A new Classification of Diabetic Nephropathy 2014: a report from Joint Committee on Diabetic Nephropathy

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Abstract

The Joint Committee on Diabetic Nephropathy has revised its Classification of Diabetic Nephropathy (Classification of Diabetic Nephropathy 2014) in line with the widespread use of key concepts, such as the estimated glomerular filtration rate (eGFR) and chronic kidney disease (CKD). In revising the Classification, the Committee carefully evaluated, as relevant to current revision, the report of a study conducted by the Research Group of Diabetic Nephropathy, Ministry of Health, Labor and Welfare of Japan. Major revisions to the Classification are summarized as follows: (i) eGFR is substituted for GFR in the Classification; (ii) the subdivisions A and B in stage 3 (overt nephropathy) have been reintegrated; (iii) stage 4 (kidney failure) has been redefined as a GFR <30 mL/min/1.73 m ², regardless of the extent of albuminuria; and (iv) stress has been placed on the differential diagnosis of diabetic nephropathy versus non-diabetic kidney disease as being crucial in all stages of diabetic nephropathy.

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Summary of Revisions to the 2011 Clinical Practice Recommendations

(2011)

Revisions to the Diagnosis and Classification of Diabetes Mellitus position statement The section on diagnosis of gestational diabetes mellitus has been revised to reflect use of the 75-g oral glucose tolerance test and new diagnostic criteria. Additions to the Standards of Medical Care in Diabetes position statement A section titled “Transitions in care for youth with diabetes” has been added. A section titled “Monogenic forms of diabetes” has been added. Revisions to the Standards of Medical Care in Diabetes position statement In addition to many small changes related to new evidence since the prior version, the following sections have undergone major changes: III. DETECTION AND DIAGNOSIS OF GESTATIONAL DIABETES MELLITUS has been revised to reflect use of the 75-g oral glucose tolerance test and new diagnostic criteria. VI.A.1. Hypertension/Blood Pressure Control has been revised to reflect new evidence reinforcing the importance of individualization of blood pressure goals. VI.B. Nephropathy Screening and Treatment has been revised to include a table of suggested management for complications of more advanced chronic kidney disease. VII.A. Children and Adolescents has been revised to remove lower limits on A1C targets and to include discussion on appropriate individualization and safety. IX. STRATEGIES FOR IMPROVING DIABETES CARE has been revised to reflect growing evidence for the effectiveness of restructuring systems of chronic care delivery.

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Summary of Revisions for the 2013 Clinical Practice Recommendations

(2012)

Revisions to the Standards of Medical Care in Diabetes—2013 In addition to many small changes related to new evidence since the prior year, and to clarify recommendations, the following sections have undergone more substantive changes: Section II.C. Screening for Type 1 Diabetes has been revised to include more specific recommendations. Section IV. Prevention/Delay of Type 2 Diabetes has been revised to reflect the importance of screening for and treating other cardiovascular risk factors. Section V.C.a. Glucose Monitoring has been revised to highlight the need for patients on intensive insulin regimens to do frequent self-monitoring of blood glucose. Section V.D. Pharmacological and Overall Approaches to Treatment has been revised to add a section with more specific recommendations for insulin therapy in type 1 diabetes. Section V.F. Diabetes Self-Management Education and Support has been revised to be consistent with the newly revised National Standards for Diabetes Self-Management Education and Support. Section V.K. Hypoglycemia has been revised to emphasize the need to assess hypoglycemia and cognitive function when indicated. Section V.M. Immunization has been updated to include the new Centers for Disease Control and Prevention (CDC) recommendations for hepatitis B vaccination for people with diabetes. Section VI.A.1. Hypertension/Blood Pressure Control has been revised to suggest that the systolic blood pressure goal for many people with diabetes and hypertension should be <140 mmHg, but that lower systolic targets (such as <130 mmHg) may be appropriate for certain individuals, such as younger patients, if it can be achieved without undue treatment burden. Section VI.A.2. Dyslipidemia/Lipid Management and Table 10 have been revised to emphasize the importance of statin therapy over particular LDL cholesterol goals in high-risk patients. Section VI.B. Nephropathy Screening and Treatment and Table 11 have been revised to highlight increased urinary albumin excretion over the terms micro- and macroalbuminuria, other than when discussion of past studies requires the distinction. Section VI.C. Retinopathy Screening and Treatment has been revised to include anti–vascular endothelial growth factor therapy for diabetic macular edema. Section IX.A. Diabetes Care in the Hospital has been revised to include a recommendation to consider obtaining an A1C in patients with risk factors for undiagnosed diabetes who exhibit hyperglycemia in the hospital. Revised Position Statement The position statement “Diagnosis and Classification of Diabetes Mellitus” has been revised slightly to add newer information about monogenic forms of diabetes. Revisions to the National Standards for Diabetes Self-Management Education and Support The task force report “National Standards for Diabetes Self-Management Education and Support” represents a major revision completed in 2012.

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Summary of Revisions for the 2012 Clinical Practice Recommendations

(2011)

Additions to the Standards of Medical Care in Diabetes—2012 A section on driving and diabetes has been added. A section and table on common comorbidities of diabetes has been added. A table listing properties of noninsulin therapies for hyperglycemia in type 2 diabetes has been added. Revisions to the Standards of Medical Care in Diabetes—2012 In addition to many small changes related to new evidence since the prior year, and to clarify recommendations, the following sections have undergone major changes: The Introduction was revised to more clearly describe processes for systematic evidence review, to link to the evidence table for changes since 2011, and to link to opportunities for public comment on the Standards of Medical Care in Diabetes—2012. Section V.D.2. Therapy for Type 2 Diabetes was revised to include more specific recommendations for starting and advancing pharmacotherapy for hyperglycemia. Section X. Strategies for Improving Diabetes Care was revised to reflect growing evidence for the effectiveness of restructuring systems of chronic care delivery. Revised Position Statement A revised position statement, “Diabetes Management at Camps for Children with Diabetes,” has been added. New Position Statement A new position statement, “Driving and Diabetes,” has been added.

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Author and article information

Journal

Journal ID (nlm-ta): J Diabetes Investig

Journal ID (iso-abbrev): J Diabetes Investig

Journal ID (publisher-id): jdi

Title: Journal of Diabetes Investigation

Publisher: BlackWell Publishing Ltd (Oxford, UK )

ISSN (Print): 2040-1116

ISSN (Electronic): 2040-1124

Publication date (Print): March 2015

Publication date (Electronic): 01 March 2015

Volume: 6

Issue: 2

Pages: 242-246

Affiliations

[1 ]Department of Medicine, Asahikawa Medical University Hokkaido, Japan

[2 ]Jikei University School of Medicine Tokyo, Japan

[3 ]Kanazawa Medical University Ishikawa, Japan

[4 ]Tokyo Women's Medical University Tokyo, Japan

[5 ]Kitasato University Kanagawa, Japan

[6 ]Okayama University Hospital Okayama, Japan

[7 ]St. Marianna University School of Medicine Kanagawa, Japan

[8 ]Niigata University Niigata, Japan

[9 ]Kanazawa University Ishikawa, Japan

[10 ]Tohoku University Hospital Miyagi, Japan

[11 ]Osaka City University Graduate School of Medicine Osaka, Japan

[12 ]Tokyo Medical University Tokyo, Japan

[13 ]Wakayama Medical University Wakayama, Japan

[14 ]Yabuki Hospital Yamagata, Japan

[15 ]Kagawa Nutrition University Saitama, Japan

[16 ]Kawasaki Medical School Hospital Hiroshima, Japan

[17 ]Kyoto University Hospital Kyoto, Japan

Author notes

* Correspondence Masakazu Haneda, Tel.: +81-166-68-2454, Fax: +81-166-68-2459, E-mail address: haneda@ 123456asahikawa-med.ac.jp

[†]

Joint Committee on Diabetic Nephropathy members are in Appendix 2.

Article

DOI: 10.1111/jdi.12319

PMC ID: 4364860

PubMed ID: 25802733

SO-VID: 3f0a66f3-604d-42e1-a49d-d5e92bb22b9b

Copyright © © 2014 Japan Diabetes Society, Japanese Society of Nephrology, Japanese Society for Dialysis Therapy, and Japan Society of Metabolism and Clinical Nutrition. Journal of Diabetes Investigation published by Asian Association of the Study of Diabetes (AASD) and Wiley Publishing Asia Pty Ltd

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

History

Date received : 12 November 2014

Date revision received : 17 November 2014

Date accepted : 17 November 2014

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A new Classification of Diabetic Nephropathy 2014: a report from Joint Committee on Diabetic Nephropathy

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Most cited references 15

Summary of Revisions to the 2011 Clinical Practice Recommendations

Summary of Revisions for the 2013 Clinical Practice Recommendations

Summary of Revisions for the 2012 Clinical Practice Recommendations

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