Renal outcomes in people with type 2 diabetes with and without albuminuria treated with SGLT-2 inhibitors and GLP-1 receptor agonists: target trial emulation
Authors' conclusion
Compared with DPP-4 inhibitors, GLP-1 receptor agonists and SGLT-2 inhibitors reduce the risk of deterioration of renal function in people with albuminuria. Little evidence of renal benefit among people without albuminuria was observed over the study follow-up period.
Study context
- Population
- People with T2D, moderate cardiovascular risk and eGFR ≥45 mL/min/1.73 m² on metformin monotherapy starting second-line treatment, 2014–2022 (BESTMED); median age 60 years, 48% women61,583 without albuminuria
- Participants
- 75,455 people
- Comparison
- GLP-1 RA or SGLT2i vs DPP-4i, by albuminuria status
- Outcome
- Deterioration of kidney function: doubling of serum creatinine or eGFR <15 mL/min/1.73 m²
- Follow-up
- Five year
Methodological detailslinked electronic health records and claims data, 10 health systems and two national health insurance plans
- Linked electronic health records and claims data
- 10 health systems and two national health insurance plans
Main finding
As reported in the abstract
Five year risk of renal outcome, by albuminuria subgroup
GLP-1 RA or SGLT2i vs DPP-4iRisk ratio (95% CI)
Without albuminuria
1.10(0.90–1.38)
With albuminuria
0.60(0.42–0.82)
Original publication
Renal outcomes in people with type 2 diabetes with and without albuminuria treated with SGLT-2 inhibitors and GLP-1 receptor agonists: target trial emulation. BMJ. Published 16 September 2026. doi:10.
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