Reverse the Effects

In the most recent years, Diabetes mellitus has become one of the most common chronic diseases that many adults and children have been diagnosed with. Patients diagnosed with this illness can either be affected by Type I or Type II diabetes. When it comes to Type I, individuals face an autoimmune disease where the insulin hormone is attacked by the immune system, making them insulin dependent. This means that since their body isn’t able to create its own insulin, patients would have to introduce insulin to their body via insulin injections. On the other hand, Type II individuals face insulin resistance, which is when the pancreas isn’t able to secrete sufficient insulin or the body isn’t responding to insulin, due to high blood sugar. When left untreated, Type II diabetes can bring further complications to the health of the patient, such as Chronic Kidney Disease (CKD). 
CKD decreases the health of a kidney as it slowly begins to lose its function of filtering waste and fluid of the blood, accumulating these toxins in the blood. A way to measure if the kidneys are working properly is through the albumin-to-creatinine ratio test, which measures the amount of albumin protein present in urine in comparison to the waste product, creatinine (Agarwal, 2025). If albumin is present at low levels, it can be a sign that kidney failure is afoot.  Without any intervention, this disease progresses to kidney failure. This can lead to dialysis, kidney transplant, and eventually, death. Currently, there are medications and treatments including renin–angiotensin system blockers, sodium–glucose cotransporter-2 (SGLT2) inhibitors, and finerenone that can help prevent the progression of this disease, but haven’t been an effective solution (Agarwal, 2025).
Rajiv Agarwal, Jennifer B. Green, Hiddo J.L. Heerspink, and other authors attempted to research lowering the urinary albumin-to-creatinine ratio with the use of finerenone and empagliflozin. Finerenone is a nonsteroidal medication that works by blocking the activated mineralocorticoid receptor (MR), while Empagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor that prevents the SGLT2 protein from entering the kidney as this protein reabsorbs glucose back into the bloodstream (Agarwal, 2025). Together, these two drugs were tested in a double-blind, randomized, international, and multicentral trial of 798 participants to see and measure its effectiveness.
In this trial, the participants were randomly divided into three groups, Finerenone alone, Empagliflozin alone, and Finerenone + Empagliflozin combination. All participants had Type II diabetes, hemoglobin levels of less than 11%, eGFR between 30 and 90 ml per minute per 1.73 m^2,  and albuminuria between 100 and 5000 grams (Agarwal, 2025). Each group had their own daily dosage of the drugs, 10 or 20 mg of Finerenone (depending on eGFR levels), 10 mg of Empagliflozin, or a combination of both (Agarwal, 2025). This resulted in providing two efficacy outcomes that were logged during different time periods, having the primary efficacy from baseline to 180 days and the secondary efficacy days later after the end trail. The trial concluded that a mixture of both finerenone and empagliflozin is the most effective treatment to significantly reduce the urinary albumin-to-creatinine ratio. In the primary efficacy outcome, the combination resulted in a 29% more effective than finerenone alone and 32% more effective than empagliflozin alone (Agarwal, 2025). In the secondary efficacy outcome, they noted the change in the urinary albumin-to-creatinine ratio between baseline. They noted that after 14 days, the ratio in the combination group decreased 30% and after 180 days, reduced to ~50% (Agarwal, 2025). 
Both drugs proved to be successful when paired together, bringing in the reduction of the urinary albumin-to-creatinine ratio (Agarwal, 2025). This signifies that there is an improvement in kidney health and function, allowing for the delay in CKD progression. Currently, it is recommended to prevent step-wise therapy and infrequent checking of urinary albumin-to-creatinine ratio as it can delay the improvement in health (Agarwal, 2025). Starting with the combination therapy and constantly monitoring the ratio will bring a greater improvement in kidney risk markers (Agarwal, 2025). Although this treatment does not necessarily help reverse the effects of type II Diabetes, it can help improve the health of the patient by preventing other complications from arising as well.