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Kidney and Cardiovascular Effectiveness of SGLT2 Inhibitors vs GLP-1 Receptor Agonists in Type 2 Diabetes
TAKE-HOME MESSAGE
- This large cohort study sought to compare SGLT2 inhibitors with GLP-1 agonists in terms of adverse renal and cardiovascular outcomes in patients with type 2 diabetes. The results were comparable between SGLT2 inhibitors and GLP-1 agonists, with no difference observed between the two groups with regard to the primary outcome (a composite of estimated glomerular filtration rate (eGFR) decline, incident end-stage renal disease, and all-cause mortality) and the risk of stroke, myocardial infarction, and heart failure hospitalization. However, SGLT2 inhibitors were associated with a significantly decreased risk of a major decline in eGFR (defined as a decrease of 40% or more). Genital mycotic infections were more common in users of SGLT2 inhibitors; however, other safety outcomes were comparable.
- SGLT2 inhibitors are associated with a significantly decreased risk of major eGFR decline in patients with type 2 diabetes.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
Emerging data suggest that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) improve kidney outcomes for people with type 2 diabetes (T2D). Direct comparisons of the kidney and cardiovascular effectiveness of GLP-1 RA with sodium-glucose cotransporter 2 inhibitors (SGLT2i), a first-line therapy for this population, are needed.
OBJECTIVES
The authors compared kidney and cardiovascular outcomes for new users of SGLT2i and GLP-1 RAs with T2D.
METHODS
Using propensity score overlap weighting, we analyzed electronic health record data from 20 U.S. health systems contributing to PCORnet between 2015 and 2020. The primary kidney outcome was a composite of sustained 40% estimated glomerular filtration rate (eGFR) decline, incident end-stage kidney disease, or all-cause mortality over 2 years or until censoring. In addition, we examined cardiovascular and safety outcomes.
RESULTS
The weighted study cohort included 35,004 SGLT2i and 47,268 GLP-1 RA initiators. Over a median of 1.2 years, the primary outcome did not differ between treatments (HR: 0.91; 95% CI: 0.81-1.02), although SGLT2i were associated with a lower risk of 40% eGFR decline (HR: 0.77; 95% CI: 0.65-0.91). Risks of mortality (HR: 1.08; 95% CI: 0.92-1.27), a composite of stroke, myocardial infarction, or death (HR: 1.03; 95% CI: 0.93-1.14), and heart failure hospitalization (HR: 0.95; 95% CI: 0.80-1.13) did not differ. Genital mycotic infections were more common for SGLT2i initiators, but other safety outcomes did not differ. The results were similar regardless of chronic kidney disease status.
CONCLUSIONS
SGLT2i and GLP-1 RAs led to similar kidney and cardiovascular outcomes in people with T2D, though SGLT2i initiation was associated with a lower risk of 40% eGFR decline. (Evaluating Comparative Effectiveness of Empagliflozin in Type 2 Diabetes Population With and Without Chronic Kidney Disease; NCT05465317).
Additional Info
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Kidney and Cardiovascular Effectiveness of SGLT2 Inhibitors vs GLP-1 Receptor Agonists in Type 2 Diabetes
J Am Coll Cardiol 2024 Aug 20;84(8)696-708, D Edmonston, H Mulder, E Lydon, K Chiswell, Z Lampron, C Shay, K Marsolo, RC Shah, WS Jones, H Gordon, W Hwang, I Ayoub, D Ford, A Chamberlain, A Rao, V Fonseca, A Chang, F Ahmad, A Hung, K Hunt, J Butler, HB Bosworth, N PagidipatiFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.