The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan.
Diabetes Obes Metab. 2024 Jun;26(6):2422-2430. doi: 10.1111/dom.15561. Epub 2024 Mar 26.
To compare the risk of developing kidney outcomes with use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) versus use of sodium-glucose cotransporter-2 (SGLT2) inhibitors among individuals with diabetes.
In this retrospective observational study, we analysed 12 338 individuals with diabetes who newly initiated SGLT2 inhibitors or GLP-1RAs using data from the JMDC claims database. The primary outcome was change in the estimated glomerular filtration rate (eGFR), estimated using a linear mixed-effects model. A 1:4 propensity-score-matching algorithm was used to compare the changes in eGFR between GLP-1RA and SGLT2 inhibitor users.
After propensity-score matching, 2549 individuals (median [range] age 52 [46-58] years, 80.6% men) were analysed (510 GLP-1RA new users and 2039 SGLT2 inhibitor new users). SGLT2 inhibitor use was associated with a slower eGFR decline when compared with GLP-1RA use (-1.41 [95% confidence interval -1.63 to -1.19] mL/min/1.73 m vs. -2.62 [95% confidence interval -3.15 to -2.10] mL/min/1.73 m).
Our analysis demonstrates the potential advantages of SGLT2 inhibitors over GLP-1RAs in terms of kidney outcomes in individuals with diabetes.
比较糖尿病患者使用胰高血糖素样肽-1 受体激动剂（GLP-1RAs）与钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂发生肾脏结局的风险。
在这项回顾性观察性研究中，我们使用 JMDC 理赔数据库中的数据，分析了 12338 例新开始使用 SGLT2 抑制剂或 GLP-1RAs 的糖尿病患者。主要结局是使用线性混合效应模型估计的肾小球滤过率（eGFR）的变化。采用 1:4 倾向评分匹配算法比较 GLP-1RA 和 SGLT2 抑制剂使用者 eGFR 的变化。
在进行倾向评分匹配后，对 2549 例患者（中位[范围]年龄 52[46-58]岁，80.6%为男性）进行了分析（510 例 GLP-1RA 新使用者和 2039 例 SGLT2 抑制剂新使用者）。与 GLP-1RA 相比，SGLT2 抑制剂的使用与 eGFR 下降速度较慢相关（-1.41[95%置信区间-1.63 至-1.19]mL/min/1.73m 比-2.62[95%置信区间-3.15 至-2.10]mL/min/1.73m）。
我们的分析表明，在糖尿病患者中，SGLT2 抑制剂在肾脏结局方面可能优于 GLP-1RAs。
