The Journal of family practice
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Chronic kidney disease (CKD) remains underrecognized by patients and clinicians in the primary care setting, largely due to its asymptomatic presentation in early stages. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have demonstrated kidney-protective effects in clinical trials-including in patients with and without type 2 diabetes (T2D)-and there are several proposed mechanisms for these benefits. Dapagliflozin and canagliflozin are SGLT2 inhibitors with indications for CKD, and only dapagliflozin is indicated for CKD in patients without T2D. Clinically relevant adverse events associated with SGLT-2 inhibitors include volume depletion, diabetic ketoacidosis, and genital mycotic infections.
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The increasing prevalence of type 1 diabetes (T1D) suggests family physicians will regularly see first-degree relatives of patients with T1D with the genetic propensity for developing T1D. T1D autoantibody screening by family clinicians addresses an important need to identify at-risk individuals early and achieve short- and long-term health benefits. Multiple T1D screening options and programs are available to clinicians that provide patient education, testing, result analysis, follow-up, and opportunity for participation in T1D prevention trials. The provider-patient relationship in family medicine places clinicians in a unique position to provide monitoring and followup crucial to family members with positive autoantibody results.