Real-World Data Confirms Protective Effects of SGLT-2 Inhibitors for Diabetic Kidney Disease

In a real-world, long-term study, investigators confirm the protective effects of sodium–glucose cotransporter-2 (SGLT-2) inhibitors on the kidneys of patients with type 2 diabetes (T2D), independent to baseline renal function and blood glucose.¹

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Diabetes is the leading cause of kidney disease, with 1 in 3 individuals with diabetes developing kidney disease in 2019, according to the National Institute of Health. When damaged, the kidneys cannot filter blood and causes wastes to build up in the bodies, and high blood glucose can damage the blood vessels in the kidney. Further, high blood pressure can also cause damage to the kidneys.²

According to the National Kidney Foundation, most individuals who have early kidney damage do not have symptoms, but a urine test once a year can be the best way to detect damage. The best treatments are to control blood sugar, blood pressure, and take angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. SGLT-2 inhibitors are a class of medication that can lower blood sugar due to T2D and has shown effectiveness to protect the kidney by preventing reabsorption of sugar, increasing sugar levels in the urine.^3,4

In the current study, investigators used medical record from 4734 individuals treated with SGLT-2 inhibitors from a single center in Beijing, China, from January 2020 to June 2021. SGLT-2 inhibitors included canagliflozin, empagliflozin, and dapagliflozin, and individuals received the prescription at least 3 times during the study period and had relevant tests for estimated glomerular filtration rate (eGFR).¹

Investigators were interested in trends of eGFR changes within 18 months post-SGLT-2 treatment and gradual increase of eGFR after SGLT-2 treatment, according to the study authors. After screening, 998 individuals were included in the study, with 65.7% being male and an average age of 60.09 years. All individuals had a confirmed diagnosis of T2D and most had developed diabetes-related complications, including diabetes peripheral neuropathy (35.8%), nephropathy (29.4%), and retinopathy (16.8%). The average hemoglobin A1c level was 8.27% and eGFT was 87.18 mL/min/1.73m2 at baseline.¹

Overall, the trend of eGFR demonstrated that the levels remained below baseline level after 15 months of treatment, but specifically in the first month after SGLT-2 inhibitors, which was when eGFR levels generally reached the lowest point. From month 12 and on, the eGFR returned to baseline levels with no statistically significant differences between eGFR and baseline levels, according to the investigators.¹

Additionally, the overall results showed that the compliance rate of HbA1c­ reached a maximum of 53% in month 12 after SGLT-2 therapy was started. Investigators reported that the value fluctuated around 50% in other time points, and 647 patients with a baseline HbA1c value of 7% or higher and change in HbA­1c compliance was similar to the overall trend. For those with an HbA1c­ of less than 7%, the compliance rate fluctuated around 75% during the follow-up period.¹

The study authors concluded that the results validated the protective benefits of the SGLT-2 inhibitors on renal function for those with T2D.¹

REFERENCES

1. Song R, Hou Q, Zhang X, et al. Retrospective analysis of the effect of SGLT-2 inhibitors on renal function in patients with type 2 diabetes in the real world. Front Pharmacol. 2024;15:1376850. Published 2024 Aug 5. doi:10.3389/fphar.2024.1376850

2. National Institute of Health. Diabetic Kidney Disease. February 2017. Accessed September 26, 2024. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/diabetic-kidney-disease

3. National Kidney Foundation. Diabetes and Kidney Disease (Stages 1-4). 2024. Accessed September 26, 2024. https://www.kidney.org/kidney-topics/diabetes-and-kidney-disease-stages-1-4

4. National Kidney Foundation. Sodium-glucose cotransporter-2 (SGLT2) inhibitors. 2024. Accessed September 26, 2024. https://www.kidney.org/kidney-topics/sodium-glucose-cotransporter-2-sglt2-inhibitors#:~:text=CKD-,Effectiveness,CKD%20and%20type%202%20diabetes