DKD is now recognized as the primary cause of chronic and end-stage-renal disease worldwide. The disease is characterized by changes in renal function and structure, followed by a gradual decline in kidney function, leading to ESRD. Risk factors for DKD include age, sex, race/ethnicity, family history of hyperglycemia and AKI. Recent studies have shown that certain medication classes, such as SGLT-2 inhibitors, can protect the kidneys independent of diabetes control. However, there are still gaps in our understanding of DKD, and its diagnosis is subjective due to the lack of a noninvasive biomarker. This makes it challenging to design clinical trials to identify effective treatments for the disease. Our review article aims to provide information on basic mechanisms of DKD, various treatment strategies and challenges by using personalized approaches to diagnosis and prevention.