Research implies that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) can improve kidney outcomes in patients with type 2 diabetes (T2D). However, data are lacking on direct comparisons of kidney and cardiovascular effectiveness of GLP-1 RA versus sodium-glucose cotransporter 2 inhibitors (SGLT2i).
Therefore, Daniel Edmonston, MD, MHS, and colleagues conducted a study comparing kidney and cardiovascular outcomes for new users of SGLT2i and GLP-1 RAs with T2D. Their results were published in the Journal of the American College of Cardiology.
The researchers analyzed the health record data of 82,272 patients from 20 US health systems using propensity score overlap weighting. Participants comprised adults aged 18 years or older with a T2D diagnosis who were newly prescribed an SGLT2i (n=35,004; 42.5%) or a GLP-1 RA (n=47,268; 57.5%) between January 1, 2015, and December 31, 2020. The median patient age was 59 years, 28.6% were non-White, and 53.3% were women.
The primary kidney outcome was a composite of sustained 40% eGFR decline, incident end-stage renal disease, or all-cause mortality over two years or until censoring. The study also investigated cardiovascular and safety outcomes.
Over a median period of 1.2 years, the primary outcome did not differ between SGLT2i and GLP-1 RA patients (HR, 0.91; 95% CI, 0.81-1.02). However, SGLT2i were associated with a significantly lower risk of 40% eGFR decline (HR, 0.77; 95% CI, 0.65-0.91). In addition, the total eGFR slope was superior for patients starting SGLT2i.
The risk 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 between groups. SGLT2i initiators were more likely to experience genital mycotic infections, but no differences were observed for other safety outcomes. The results were similar regardless of chronic kidney disease status.
In conclusion, initiating SGLT2i was associated with a lower risk of 40% eGFR decline and a superior eGFR slope compared with initiating GLP-1 RA. However, there were no significant differences observed between SGLT2i and GLP-1 RA regarding kidney and cardiovascular outcomes.
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