Table 3 Recommendations for people with type 2 diabetes and early CKD stages 1–3

1. In people with type 2 diabetes and hypertension, we recommend salt intake of < 90 mmol per day (< 2 g per day of sodium – equivalent to 5 g of sodium chloride) (Grade 1C).

2. In people with type 2 diabetes, CKD and urine albumin:creatinine ratio (UACR) < 3 mg/mmol (< 26.55 mg/g), we recommend that their target upright blood pressure should be < 140/90 mmHg, using antihypertensive therapy in the maximum tolerated doses (Grade 1D).

3. In people with type 2 diabetes, CKD and UACR of > 3 mg/mmol (> 26.55 mg/g), we suggest aiming for a target upright blood pressure that is consistently < 130/80 mmHg, using antihypertensive therapy in the maximum tolerated doses (Grade 2D).

4. There is no evidence to support either ACEI or ARB therapy as first-line blood pressure lowering agents in comparison with other antihypertensive agents in people with type 2 diabetes, normal renal function and normal UACR (< 3 mg/mmol [< 26.55 mg/g]) (Grade 1A).

5. We suggest that ACEIs (or ARBs if ACEIs are not tolerated) should be preferentially used in people with type 2 diabetes and CKD who have UACR > 3 mg/mmol (> 26.55 mg/g). We recommend that the dose of ACEI (or ARB) should be titrated to the maximum tolerated (Grade 2D).

6. There is currently no evidence to support the role of home or ambulatory blood pressure monitoring in people with type 2 diabetes and CKD stages 2 and 3 (Grade 1D).

7. There is currently no evidence to support the role of dual blockade of the RAAS in people with type 2 diabetes and CKD stages 1 to 3 (Grade 1B).

8. Upright blood pressure targets should be set at no lower than 150/90 mmHg in those with type 2 diabetes who are aged 75 years or over (Grade 2B).

9. We recommend that people with type 2 diabetes should be advised to stop RAAS-blocking drugs during periods of acute illness and restarted 24–48 h after recovery from the illness (Grade 1C).