Kidney disease affects more than one third of people with diabetes and is the most common cause of renal failure on a global scale. People with diabetes can get kidney disease as result of poor control of glucose levels or other secondary causes like infections, autoimmune diseases, harmful medications etc. Preventing diabetic kidney disease needs a proactive approach with optimal management of lifestyle, medications to control the risk factors, and regular screening. Lifestyle changes are key in control of the metabolic risk factors for the kidney disease. Portion control of carbohydrates with increasing the vegetables, and lean proteins is important for good glycemic control. Eliminate simple carbs and processed sugars. Salt restriction is necessary for control of hypertension. A physical activity schedule involving aerobic and resistance training with at least 150 minutes of moderate activity is necessary. Weight loss of even 5% can improve the insulin sensitivity and reduce the blood pressure. See More: Diabetes Symptoms: 10 silent symptoms that could be hiding in plain sightAdequate hydration is important for renal health. People with diabetes are at a higher risk for urinary infections. It is important to screen and treat the urinary infections promptly as ascending infections often cause renal dysfunction. Especially people with additional risk factors like urinary stones, phimosis, and urethral strictures etc. need to be extra cautious. Medications such as NSAIDs, antifungals, and antibiotics which can potentially lead to renal injury should be used cautiously under medical supervision.When choosing the medications in patients with diabetes, the risk for kidney disease needs to be considered. We have medications like SGLT2 inhibitors, and GLP1 receptor agonists which can reduce the progression of kidney damage independent of the glucose control they provide. For patients with early signs of renal damage like proteinuria, these medications can delay and potentially prevent the onset of kidney disease. In addition, we need to control the cholesterol levels to optimal targets for reduction of cardiovascular events in addition to renal protection. Medications used for control of blood pressure like ACE inhibitors and ARBs also reduce the proteinuria and help in prevention of progression of the kidney disease. We have a new class of medications called non-steroidal MR blockers e.g. Finerenone which also reduce the proteinuria and prevent kidney disease progression. With the help of lifestyle measures and appropriate medications, we should target optimal glucose levels with Hba1c