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As diabetes is a major risk factor for CKD [67], specialized expert groups such as the Kidney Disease: Improving Global Outcomes (KDIGO) team, with the endorsement of both ADA and EASD, recommend that glycemic management for T2D patients with CKD should involve a combination of metformin and a SGLT-2 inhibitor as first-line therapy, with other drugs such as SUs considered only when additional therapies are needed for optimum glycemic control [68]

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Most currently available ways to influence this axis, including AMPK activation or mTOR modulation, are systemic and pleiotropic, so their net effects are unlikely to reflect pancreas-specific restoration of mitochondrial quality control alone