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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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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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Journal Article
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
2024
Overview
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.
Publisher
BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
Subject
/ Agonists
/ Body fat
/ Dextrose
/ Diabetes
/ Diabetes mellitus (non-insulin dependent)
/ Diabetes Mellitus, Type 2 - drug therapy
/ eGFR
/ Enzymes
/ Epidermal growth factor receptors
/ Female
/ Glomerular Filtration Rate - drug effects
/ Glucagon
/ Glucagon-Like Peptide-1 Receptor - agonists
/ Glucose
/ Humans
/ Hypoglycemic Agents - therapeutic use
/ Lipids
/ Male
/ Medicine
/ Methods
/ Patients
/ Peptides
/ Plasma
/ Sodium
/ Sodium-Glucose Transporter 2 Inhibitors - therapeutic use
/ Therapy
