The concomitant use of sodium-glucose co-transporter 2 inhibitors improved the renal outcome of Japanese patients with type 2 diabetes treated with glucagon-like peptide 1 receptor agonists

Kazuo Kobayashi; Masao Toyoda; Nobuo Hatori; Shunichiro Tsukamoto; Moritsugu Kimura; Hiroyuki Sakai; Takayuki Furuki; Keiichi Chin; Tomohiko Kanaoka; Togo Aoyama; Tomoya Umezono; Shun Ito; Daisuke Suzuki; Hiroshi Takeda; Hisakazu Degawa; Toshimasa Hishiki; Hidetoshi Shimura; Shinichi Nakajima; Masaaki Miyauchi; Hareaki Yamamoto; Yutaka Hatori; Masahiro Hayashi; Kazuyoshi Sato; Masaaki Miyakawa; Yasuo Terauchi; Kouichi Tamura; Akira Kanamori

doi:10.1097/XCE.0000000000000292

The concomitant use of sodium-glucose co-transporter 2 inhibitors improved the renal outcome of Japanese patients with type 2 diabetes treated with glucagon-like peptide 1 receptor agonists

Cardiovasc Endocrinol Metab. 2023 Sep 28;12(4):e0292. doi: 10.1097/XCE.0000000000000292. eCollection 2023 Dec.

Authors

Kazuo Kobayashi^{1

2}, Masao Toyoda³, Nobuo Hatori¹, Shunichiro Tsukamoto², Moritsugu Kimura³, Hiroyuki Sakai¹, Takayuki Furuki¹, Keiichi Chin¹, Tomohiko Kanaoka², Togo Aoyama⁴, Tomoya Umezono¹, Shun Ito¹, Daisuke Suzuki¹, Hiroshi Takeda¹, Hisakazu Degawa¹, Toshimasa Hishiki¹, Hidetoshi Shimura¹, Shinichi Nakajima¹, Masaaki Miyauchi¹, Hareaki Yamamoto¹, Yutaka Hatori¹, Masahiro Hayashi¹, Kazuyoshi Sato¹, Masaaki Miyakawa¹, Yasuo Terauchi⁵, Kouichi Tamura², Akira Kanamori¹

Affiliations

¹ Committee of Hypertension and Kidney Disease, Kanagawa Physicians Association.
² Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama.
³ Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, lsehara.
⁴ Division of Nephrology, Department of internal medicine, Kitasato University School of Medicine, Sagamihara.
⁵ Department of Endocrinology and Metabolism, Yokohama City University Graduate School of Medicine, Yokohama, Japan.

Abstract

Aims: This study aimed to clarify the renal influence of glucagon-like peptide 1 receptor agonists (GLP1Ras) with or without sodium-glucose co-transporter 2 inhibitors (SGLT2is) on Japanese patients with type 2 diabetes mellitus (T2DM).

Methods: We retrospectively extracted 547 patients with T2DM who visited the clinics of members of Kanagawa Physicians Association. The progression of albuminuria status and/or a ≥ 15% decrease in the estimated glomerular filtration rate (eGFR) per year was set as the renal composite outcome. Propensity score matching was performed to compare GLP1Ra-treated patients with and without SGLT2i.

Results: After matching, 186 patients in each group were compared. There was no significant difference of the incidence of the renal composite outcomes (17% vs. 20%, P = 0.50); however, the annual decrease in the eGFR was significantly smaller and the decrease in the urine albumin-to-creatinine ratio was larger in GLP1Ra-treated patients with the concomitant use of SGLT2is than in those without it (-1.1 ± 5.0 vs. -2.8 ± 5.1 mL/min/1.73 m², P = 0.001; and -0.08 ± 0.61 vs. 0.05 ± 0.52, P = 0.03, respectively).

Conclusion: The concomitant use of SGLT2i with GLP1Ra improved the annual decrease in the eGFR and the urine albumin-to-creatinine ratio in Japanese patients with T2DM.

Keywords: glucagon; glucose co-transporter 2 inhibitors; like peptide 1 receptor agonist; renal outcome; sodium.