BMC Med. 2024;22(1):273.

Long-term comparison of renal and metabolic outcomes after sodium-glucose co-transporter 2 inhibitor or glucagon-like peptide-1 receptor agonist therapy in type 2 diabetes.

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제1저자 손민지 · 교신저자 임수

PMID 38956548 PMC11218058 DOI 10.1186/s12916-024-03483-z IF 8.7 내분비대사내과

소속 (3)

Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-City, 13620, South Korea.
Section Diabetes, Endocrinology, Metabolism, Medical Department I Katholisches Klinikum Bochum gGmbH, St. Josef Hospital Ruhr-University Bochum, Bochum, Germany.
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-City, 13620, South Korea. limsoo@snu.ac.kr.

Abstract

BACKGROUND Renal outcomes in patients with type 2 diabetes following treatment with sodium-glucose co-transporter-2 inhibitors (SGLT2is) or glucagon-like peptide-1 receptor agonists (GLP1RAs) have not been directly compared. This study compared the impact of SGLT2i and GLP1RA therapy on renal function and metabolic parameters.

METHODS Patients with type 2 diabetes who initiated SGLT2i or GLP1RA therapy in a tertiary hospital between January 2009 and August 2023 were included to assess composite renal outcomes, such as a 40% decline in estimated glomerular filtration rate (eGFR), onset of end-stage renal disease, renal death, or new-onset macroalbuminuria. Alterations in blood pressure, glucose regulation parameters, lipid profile, and anthropometric parameters, including body fat and muscle masses, were examined over 4-years.

RESULTS A total of 2,112 patients were enrolled using a one-to-three propensity-score matching approach (528 patients for GLP1RAs, 1,584 patients for SGLT2i). SGLT2i treatment was favoured over GLP1RA treatment, though not significantly, for composite renal outcomes (hazard ratio [HR], 0.63; p = 0.097). SGLT2i therapy preserved renal function effectively than GLP1RAs (decrease in eGFR, ≥ 40%; HR, 0.46; p = 0.023), with improving albuminuria regression (HR, 1.72; p = 0.036). SGLT2i therapy decreased blood pressure and body weight to a greater extent. However, more patients attained HbA_1c levels < 7.0% with GLP1RAs than with SGLT2is (40.6% vs 31.4%; p < 0.001). GLP1RA therapy enhanced β-cell function and decreased LDL-cholesterol levels below baseline values.

CONCLUSIONS SGLT2is were superior for preserving renal function and reducing body weight, whereas GLP1RAs were better for managing glucose dysregulation and dyslipidaemia.

Keywords

AlbuminuriaGLP1 receptor agonistRenal outcomeSGLT2 inhibitoreGFR

Figures

**Fig. 1** Cumulative incidence of renal outcomes. a Composite renal outcomes, (b) sustained reduction in eGFR ³40%, (c) end-stage renal disease, (d) new-onset macroalbuminuria, (e) albuminuria progression, and (f) albuminuria regression. GLP1RA, glucagon-like peptide-1 receptor agonists; SGLT2i, sodium–glucose co-transporter-2 inhibitors. p values were calculated for the log-rank test conducted between the two groups

**Fig. 2** Changes in clinical parameters related to renal function and glycaemic control: (a) albuminuria, (b) eGFR, (c) HbA_1c, (d) FE_glucose, (e) fasting glucose, (f) postprandial 2-h glucose, (g) HOMA-IR, and (h) HOMA-β. ACR, albumin-to-creatinine ratio; FE, fractional excretion. ^aSignificant change from baseline with GLP1RAs. ^bSignificant change from baseline with SGLT2is. ^*Significant difference between the two groups of changes from the baseline value by paired comparison. p values indicate the difference between the two groups by mixed-effect models for repeated measures (MMRM) by defined time point

그림 출처: PubMed Central 공개 논문 (PMC11218058)

Conflict of interest statement

The authors declare that they have no competing interests.

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