A RECENT real-world study has found that sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists are more effective at reducing kidney complications in adults with Type 2 diabetes and moderate cardiovascular risk compared to dipeptidyl peptidase-4 (DPP-4) inhibitors and sulfonylureas.
The retrospective observational study, which analysed data from 364,714 adults to assess how these medications impacted the development of chronic kidney disease (CKD), kidney failure, or the need for kidney replacement therapy. The study population included 78,843 people prescribed DPP-4 inhibitors, 42,049 on GLP-1 receptor agonists, 45,466 using SGLT2 inhibitors, and 198,356 prescribed sulfonylureas.
According to the team current guidelines do not recommend the preferential use of SGLT2 inhibitors or GLP-1 receptor agonists over other glucose-lowering therapies for patients with moderate cardiovascular disease (CVD) risk. However, previous large cardiovascular outcome trials have shown these medications offer both cardiovascular and kidney benefits.
In this study, SGLT2 inhibitors demonstrated the greatest effectiveness in reducing kidney complications. Compared to DPP-4 inhibitors, SGLT2 inhibitors were associated with a 29% lower risk of developing CKD stages 3 through 5, kidney failure, or requiring kidney replacement therapy. GLP-1 receptor agonists were also effective, reducing these risks by 13%. When compared to sulfonylureas, SGLT2 inhibitors reduced kidney risks by 28%, and GLP-1 agonists reduced them by 14%.
SGLT2 inhibitors were found to be superior to GLP-1 receptor agonists for the main composite outcome, offering a greater reduction in kidney complications.
“These findings provide important real-world evidence to support clinical decision-making for patients with Type 2 diabetes and moderate CVD risk,” the researchers concluded. The study demonstrated the potential benefits of prioritizing SGLT2 inhibitors and GLP-1 receptor agonists in managing patients at risk of kidney disease, potentially altering the future of diabetes care.
Reference
Neumiller JJ et al. Kidney outcomes with GLP-1RAs, SGLT2 inhibitors, DPP-4 inhibitors, and sulfonylureas in Type 2 diabetes and moderate cardiovascular risk. Clin J Am Soc Nephrol. 2024;DOI: 10.2215/CJN.0000000587.
