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Clinical Triggers to Initiate Therapy Key clinical indicators for early therapy include: Persistent microalbuminuria or macroalbuminuria (ACR 30 mg/g) eGFR decline, even within the normal range Coexisting cardiovascular disease Suboptimal HbA1c despite metformin and lifestyle modification SGLT2 inhibitors are generally safe to initiate if eGFR is above 30 mL/min/1.73 m