Kidney function loss and albuminuria progression with GLP-1 receptor agonists versus basal insulin in patients with type 2 diabetes: real-world evidence
Authors' conclusion
Initiation of GLP-1 RAs in a real-world setting is associated with a reduced risk of albuminuria progression and possible mitigation of kidney function loss in patients with T2D and mostly preserved kidney function.
Study context
- Population
- Adults with T2D treated with ≥ 2 glucose-lowering agents initiating GLP-1 RAs or basal insulin 2010–2019, Maccabi Healthcare Services database, Israel; 45% women, 21% history of CVD, mean eGFR 90.6 mL/min/1.73 m² (SD 19.3), median UACR 14.6 mg/g [IQR 0.0–54.7]propensity-score matched
- Participants
- 3,424 vs 3,424
- Exposure
- GLP-1 RA initiation vs basal insulin initiation
- GLP-1 RAsn = 3,424
- Basal insulinn = 3,424reference
- Outcome
- Composite kidney outcome:
- Confirmed ≥ 40% eGFR loss
- End-stage kidney disease
- Follow-up
- Median 81.1 months (ITT), 22.3 months (AT)
Methodological detailspropensity-score matched (1:1), real-world database
- Propensity-score matched (1:1)
- Real-world database
Main finding
As reported in the abstract
Composite kidney outcome
GLP-1 RAs vs Basal insulinHazard ratio (95% CI)P value
ITT analysis
0.96(0.82–1.11)
P = 0.566As-treated analysis
0.71(0.54–0.95)
P = 0.020Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| First new macroalbuminuriaGLP-1 RAsvs Basal insulinITT analysis | 0.87 (0.75–0.997) | |
| First new macroalbuminuriaGLP-1 RAsvs Basal insulinAs-treated analysis | 0.80 (0.64–0.995) | |
| 0.512Hazard ratio (log scale) |
| Outcome | Mean annual between-group difference (mL/min/1.73 m²/year) (95% CI) | P value | |
|---|---|---|---|
| eGFR slopeLess steep eGFR slope with GLP-1 RAs; as-treated analysis · as-treated analysis | 0.42 (0.11–0.73) | P = 0.008 | |
| −0.500.51Difference, mL/min/1.73 m²/year (linear scale) |
Original publication
Kidney function loss and albuminuria progression with GLP-1 receptor agonists versus basal insulin in patients with type 2 diabetes: real-world evidence. Cardiovasc Diabetol. Published 27 May 2023. doi:10.
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