The importance of treatment sequencing with SGLT2 inhibitors and GLP ‐1 receptor agonists combination for kidney function preservation in type 2 diabetes
Main finding · eGFR declineResult — go to the resultAdjusted difference 0.80 mL/min/1.73 m² per year 95% CI 0.23–1.37Authors' conclusion
In people with T2D receiving combination therapy, initiating treatment with a SGLT2i was associated with greater long-term preservation of kidney function compared with starting with a GLP-1RA. Early SGLT2i use may confer better renal protection even when GLP-1RA intensification is subsequently required, confirming SGLT2i as a foundational therapy for preventing the decline in renal function in T2D.
Study context
- Population
- Adults with T2D treated with both a SGLT2i and a GLP-1RA; mean age 64 years, 29% women, diabetes duration 14 years, baseline estimated glomerular filtration rate (eGFR) 80 mL/min/1.73 m²
- Participants
- 565 adults
- Exposure
- SGLT2i first then GLP-1RA vs GLP-1RA first then SGLT2i
- SGn = 210
- GSn = 355reference
- Outcome
- Change in eGFR from initiation of the first drug
- Follow-up
- median 4.3-year follow-up
Methodological detailsInverse probability of treatment weighting (IPTW)-adjusted mixed models for repeated measures, confirmed by propensity score matching
- IPTW-adjusted mixed models for repeated measures
- Confirmed by propensity score matching
Main finding
eGFR decline
Adjusted difference
0.80 mL/min/1.73 m² per year
95% CI 0.23–1.37
P = 0.006
As reported in the abstract
Observational data: associations, not effects.
Further findings
eGFR decline in patients with CKD at baseline
- Effect more evident in patients with CKD at baseline
Changes in urine albumin-to-creatinine ratio, HbA1c and body weight
- Similar between groups
Original publication
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