SGLT2 inhibitors and mortality in older adults with diabetic kidney disease: A target trial emulation study
Main finding · All-cause mortalityResult — go to the resultHazard ratio 0.51 95% CI 0.38–0.70Authors' conclusion
In this target trial emulation study, SGLT2 inhibitors were associated with lower mortality in older adults with DKD, particularly those under 80 years and with BMI ≥22 kg/m2. These findings support personalized treatment decisions for this high-risk population in clinical practice.
Study context
- Population
- Adults aged ≥65 years with diabetic kidney disease (DKD), nationwide claims and health checkup database in Japan437 deaths
- Participants
- 5,371 adults
- Exposure
- SGLT2i vs DPP-4i initiators
- Outcome
- All-cause mortality
- Follow-up
- Median 2.23 (IQR, 1.07-3.49) years
Methodological detailsnationwide claims and health checkup database, propensity score overlap weighting, Cox proportional hazards models
- Nationwide claims and health checkup database
- Propensity score overlap weighting
- Cox proportional hazards models
Main finding
As reported in the abstract
median follow-up 2.23 years
Hazard ratio
0.51
95% CI 0.38–0.70
SGLT2ivs DPP-4i
HR 0.51 (95% CI 0.38–0.70)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| All-cause mortality, per-protocol analysis (sensitivity)SGLT2ivs DPP-4i | 0.50 (0.35–0.73) | |
| 0.20.5125Hazard ratio (log scale) |
- All-cause mortality, per-protocol analysis (sensitivity): per-protocol analysis with inverse probability of censoring weighting
Effect modification by age, body mass index (BMI) and Charlson comorbidity index (CCI)
- Survival benefit evident up to about 80 years of age and among individuals with BMI ≥22 kg/m², irrespective of CCI
Original publication
SGLT2 inhibitors and mortality in older adults with diabetic kidney disease: A target trial emulation study. Diabetes Obes Metab. Published 23 January 2026. doi:10.
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