Type 2 diabetes patients with nephropathy, also known as diabetic nephropathy, face significant risk of kidney failure—a condition associated with extreme morbidity, mortality, and cost. Current therapies have limited efficacy, and are unable to prevent progressive renal decline once diabetic nephropathy sets in. As a result, physicians report high unmet need for safe and efficacious therapies within this indication. Early-and late-stage pipeline activity reflects the important clinical and economic implications for developing a disease-modifying therapy able to significantly slow or halt disease progression among diabetic nephropathy patients. Understanding the influence and importance of key efficacy, safety/tolerability, and nonclinical attributes on physician prescribing will be paramount for a therapy to achieve commercial success within this indication.