Diabetic drugs that inherently offer cardiac and renal protection is now a reality. Recent landmark trials have demonstrated these effects especially with sodium glucose cotransporter 2 inhibitors and glucagon like peptide -1 analogues. This raises further questions regarding which diabetic combination therapy is the best in the clinical setting. The challenges in clinical trials evaluating hard renal endpoints will be discussed followed by the recent evidence around the validity of urinary albumin levels as a surrogate endpoint.