- Choose Conventional or SI (IFCC / mmol) units so the HbA1c and glucose outputs match your lab report.
- Enter the most recent eGFR, HbA1c, and spot UACR.
- Select whether the patient is already on an SGLT2 inhibitor (and which one) so the tool can confirm continuation versus flag a new start.
- Results update live: SGLT2i eligibility/continuation status, the estimated average glucose for the entered HbA1c, and the UACR risk category — each with a colored badge and a plain-language interpretation and recommended action.
All computation runs in your browser; no values are stored or transmitted.
When to Use
Use this tool when reviewing a patient with type 2 diabetes and chronic kidney disease to make three linked decisions at once: whether eGFR is high enough to start (or continue) a kidney-protective SGLT2 inhibitor, what a given HbA1c means as a day-to-day average glucose, and how the urine albumin-to-creatinine ratio classifies albuminuria-based risk. It is a fast bedside check that pulls the relevant trial thresholds and KDIGO categories into one view.
Appropriate population
Adults with type 2 diabetes and CKD (or albuminuria) who have a recent eGFR, HbA1c, and spot UACR. Most useful when deciding whether to initiate an SGLT2 inhibitor for kidney and cardiovascular protection, and when counseling a patient on what their HbA1c means in everyday glucose terms.
When NOT to rely on it
The eAG conversion assumes a stable, reliable HbA1c; it is unreliable in conditions that alter red-cell turnover (hemolysis, recent transfusion, iron-deficiency anemia, advanced CKD, hemoglobinopathies). UACR is affected by intercurrent illness, menstruation, heavy exercise, and UTI — confirm a persistent elevation on a repeat sample. SGLT2i eligibility shown here is a starting screen only; the full prescribing decision (volume status, recurrent genital infection, ketoacidosis risk, drug interactions) requires physician judgment.
Pearls & Pitfalls
Start by threshold, continue through decline
Once an SGLT2 inhibitor is appropriately started above the eGFR cutoff, it is generally continued as kidney function falls — the kidney and cardiovascular benefit persists. Do not stop it simply because eGFR has drifted below the original start threshold.
HbA1c is a target, not a tightrope
In CKD, an HbA1c around 7.0–7.5% is usually appropriate; pushing below 7% raises hypoglycemia risk for little renal benefit. Use the eAG to make the number meaningful, but interpret HbA1c cautiously in anemia, recent transfusion, or advanced CKD where it can read falsely low.
Pitfalls
(1) A single elevated UACR is not a diagnosis — confirm persistence on a repeat sample, and avoid testing during UTI, fever, menstruation, or after heavy exercise. (2) eAG is unreliable whenever red-cell lifespan is altered. (3) This screen does not capture SGLT2i contraindications and cautions (recurrent genital mycotic infection, volume depletion, ketoacidosis risk, perioperative holds) — the prescribing decision is still clinical.
Why Use It
SGLT2 inhibitors slow CKD progression and reduce cardiovascular and kidney events in diabetic kidney disease, but the eGFR thresholds at which they were proven and can be started differ by agent — dapagliflozin and empagliflozin were studied to lower eGFR levels than older trials assumed. Knowing the correct cutoff avoids both under-treatment and inappropriate starts. Translating HbA1c into an estimated average glucose makes the target tangible for patients, and the UACR category drives both prognosis and the intensity of renin-angiotensin blockade and SGLT2i therapy. Computing all three together keeps these decisions coherent.
DKD Risk & Treatment Calculator — SGLT2i Eligibility, HbA1c, UACR
Enter your most recent lab results to check whether you qualify for kidney-protective SGLT2 inhibitor therapy, see what your HbA1c means in average daily glucose, and understand your UACR risk category.
⚕ eAG = 28.7 × HbA1c − 46.7 (ADA formula). SGLT2i eligibility thresholds: dapagliflozin eGFR ≥25 (DAPA-CKD trial); empagliflozin eGFR ≥20 (EMPA-KIDNEY trial). UACR categories per KDIGO 2024. Prescribing decisions require physician evaluation. Philippine brands: dapagliflozin = Catania or Rhea (cost-effective); empagliflozin = Jardiance.
Next Steps
Use the result to support — not replace — clinical judgment.
- Interpret the value against the targets shown in the calculator and the Evidence section below, in the context of the full clinical picture.
- Trend serial measurements rather than acting on a single result; confirm abnormal or unexpected values before changing management.
- Apply the relevant KDIGO / specialty-guideline threshold and document the indication.
- Escalate or refer to nephrology when results are out of range, rapidly changing, or discordant with the clinical picture — and discuss the implications with the patient.
Evidence & References
Formula & Equations
| Quantity | Equation / Rule |
|---|---|
| Estimated average glucose (mg/dL) | 28.7 × HbA1c (%) − 46.7 |
| Estimated average glucose (mmol/L) | 1.59 × HbA1c (%) − 2.59 |
| HbA1c IFCC (mmol/mol) → NGSP (%) | NGSP % = (IFCC mmol/mol ÷ 10.929) + 2.15 |
| Dapagliflozin start threshold | eGFR ≥ 25 mL/min/1.73 m² (DAPA-CKD) |
| Empagliflozin start threshold | eGFR ≥ 20 mL/min/1.73 m² (EMPA-KIDNEY) |
UACR (albuminuria) categories — KDIGO
| Category | UACR | Descriptor |
|---|---|---|
| A1 | < 30 mg/g (< 3 mg/mmol) | Normal to mildly increased |
| A2 | 30–300 mg/g (3–30 mg/mmol) | Moderately increased (microalbuminuria) |
| A3 | > 300 mg/g (> 30 mg/mmol) | Severely increased (macroalbuminuria) |
The eAG equation is the ADAG (A1c-Derived Average Glucose) study regression. Once an SGLT2 inhibitor is started above the threshold, current guidance is to continue it as eGFR declines (even below the start cutoff) unless dialysis is initiated or it is not tolerated.
Evidence & References
SGLT2 inhibitor thresholds and the role of UACR in risk stratification follow the KDIGO 2022 guideline on diabetes management in CKD. The estimated-average-glucose conversion uses the regression derived in the ADAG study, which is also the basis for the ADA's eAG reporting.
- Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int. 2022;102(5S):S1–S127.
- Nathan DM, Kuenen J, Borg R, Zheng H, Schoenfeld D, Heine RJ; A1c-Derived Average Glucose (ADAG) Study Group. Translating the A1C assay into estimated average glucose values. Diabetes Care. 2008;31(8):1473–1478.
