Real‐world impact of adding a glucagon‐like peptide‐1 receptor agonist compared with basal insulin on metabolic targets in adults living with type 2 diabetes and chronic kidney disease already treated with a sodium‐glucose co‐transporter‐2 inhibitor: The Impact GLP‐1 chronic kidney disease (CKD) study
Authors' conclusion
The study shows the real-world effectiveness of GLP-1 RA therapy for T2D and CKD. GLP-1 RAs provided superior reductions in HbA1c and weight, and greater kidney protection, compared with basal insulin among adults with T2D and CKD already treated with an SGLT2i.
Study context
- Population
- Adults with T2D and CKD already treated with an SGLT2i and not reaching glycaemic targets; Canadian LMC Diabetes Registrymatched 1:1
- Participants
- 153 vs 153
- Exposure
- Adding GLP-1 RA vs basal insulin
- GLP-1 RAn = 153
- Basal insulinn = 153reference
- Outcome
- Change in HbA1c
- Follow-up
- 26-52 weeks
Methodological detailspropensity-score matched, registry-based
- Propensity-score matched
- Registry-based
Main finding
As reported in the abstract
GLP-1 RA
−1.3
± 1.4% · %
Basal insulin
−1.1
± 1.4% · %
P = 0.03
Observational data: associations, not effects.
Further findings
| Outcome | GLP-1 RA | Basal insulin | P value |
|---|---|---|---|
| Change in weight · 26-52 weeks | −3.4 ± 3.7 kg | 2.6 ± 4.5 kg | P < 0.001 |
| Change in eGFR · 26-52 weekseGFR decline slowed with GLP-1 RA | −0.3 ± 8.2 mL/min/1.73m2 | −2.4 ± 10.4 mL/min/1.73m2 | P = 0.02 |
| Change in albuminuria · 26-52 weeksNot significantly different | −5.7 ± 38.1 mg/mmol | −0.5 ± 38.3 mg/mmol | P = 0.47 |
Safety
Hypoglycaemia and therapy discontinuation
- No differences in self-reported hypoglycaemic events per week and therapy discontinuations between cohorts
Original publication
Real‐world impact of adding a glucagon‐like peptide‐1 receptor agonist compared with basal insulin on metabolic targets in adults living with type 2 diabetes and chronic kidney disease already treated with a sodium‐glucose co‐transporter‐2 inhibitor: The Impact GLP‐1 CKD study. Diabetes Obes Metab. Published 7 August 2024. doi:10.
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