NAD Augmentation in Diabetes Kidney Disease

Eligibility Criteria

• 1. Has T2DM, as indicated by any of the following:
• 1. Self-report of diabetes plus the use of a prescribed diabetes medication.
• 2. ICD-10 code for diabetes plus current use of a diabetes medication in the electronic medical record.
• 3. HbA1c \>6.4%; or 2 fasting glucose \> 125 mg/dL
• 2. Fasting morning UACR between 100 and 2,000 mg/g creatinine on two separate days
• 3. If UACR is \> 300 mg/g creatinine, must be currently using an ACE inhibitor or an ARB
• 4. eGFR \> 30 mL/ min / 1.73 m2
• 5. Hemoglobin A1c \<9%
• 6. Able to speak English or Spanish
• 7. Willing and able to provide written informed consent
• 8. In addition, female participants must Not be pregnant and not planning to become pregnant over the next 6 months
• 1. Fasting morning UACR \> 2,000 mg/ g creatinine
• 2. Other laboratory abnormalities:
• 1. Has AST or ALT \> 3 times the upper limit of normal
• 2. creatinine \> 2.5 mg/dL
• 3. Hematocrit \< 0.34 or 0.50 L/L
• 3. A major adverse cardiovascular event in preceding 3 months
• 4. Participation in an investigational trial to evaluate pharmaceuticals or biologics within the past 3 months or 5 half-lives, whichever is shorter
• 5. Hypoglycemia unawareness or other medical conditions which could jeopardize participant's safety.
• 6. History of alcohol or substance use disorder or dependence (DSM 5 criteria) within the last 2 years.
• 7. Major depressive disorder, bipolar disorder, schizophrenia, or current psychotic symptoms or behavioral problems that could interfere with study procedures.
• 8. BMI \> 42.5 kg/ m2