The pathogenesis of DKD also involves the activation of a plethora of potential biochemical pathways including but not limited to the activation of diacylglycerol (DAG)/protein kinase Cβ (PKCβ) and AGE/RAGE axes and RAAS, oxidative stress, inflammation, albuminuria, EndMT and glomerular hyperfiltration.147 Besides their anti-hyperglycaemic effects, DPP-4 inhibitors could exert renoprotective effects in DKD through pleiotropic actions that are mediated via GLP-1R-dependent and GLP-1R-independent mechanisms.136. This evidence concerns the gene GLP1R and diabetic kidney disease.