Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan.
Clin Exp Nephrol. 2024 Sep;28(9):894-901. doi: 10.1007/s10157-024-02499-2. Epub 2024 Apr 13.
Limited direct comparative studies exist in terms of the effects of sodium-glucose cotransporter 2 inhibitors (SGLT2is) and dipeptidyl peptidase-4 inhibitors (DPP4is) on the kidney outcomes in Japanese individuals with type 2 diabetes.
This retrospective cohort study included 561 Japanese adults with type 2 diabetes, who were newly prescribed either an SGLT2i or a DPP4i and had an eGFR ≥ 30 mL/min/1.73 m. The cohort comprised 207 women and 354 men, with a mean (± standard deviation) age of 63 (± 12) years. The exposure and outcome were SGLT2i or DPP4i initiation and eGFR slope during the overall follow-up period, restricted to participants who were followed for ≥2 years. We adopted the on-treatment analysis. Analysis of covariance was used to compare the adjusted eGFR slope between the two groups, incorporating 10 variables at baseline.
During the median follow-up period of 3.4 years, least square mean (95% CI) eGFR slopes were -1.91 (-2.15, -1.67) and -1.12 (-1.58, -0.67) mL/min/1.73 m/year in individuals treated with a DPP4i (n = 460) and an SGLT2i (n = 101), respectively, demonstrating statistical significance (p = 0.002). The robustness of this finding was strengthened by sensitivity analyses.
This study provides potential evidence of the superiority of SGLT2is over DPP4is in slowing kidney function decline in Japanese adults with type 2 diabetes and eGFR ≥ 30 mL/min/1.73 m.
在日本 2 型糖尿病患者中，关于钠-葡萄糖共转运蛋白 2 抑制剂 (SGLT2i) 和二肽基肽酶-4 抑制剂 (DPP4i) 对肾脏结局影响的直接比较研究有限。
本回顾性队列研究纳入了 561 名新诊断的 2 型糖尿病且肾小球滤过率 (eGFR)≥30 mL/min/1.73 m 的日本成年人，他们接受 SGLT2i 或 DPP4i 治疗。队列包括 207 名女性和 354 名男性，平均(±标准差)年龄为 63(±12)岁。暴露因素和结局为 SGLT2i 或 DPP4i 的起始治疗以及整个随访期间的 eGFR 斜率，限于随访时间≥2 年的参与者。我们采用治疗期间分析。采用协方差分析比较两组间调整后的 eGFR 斜率，共纳入 10 个基线变量。
在中位随访 3.4 年期间，接受 DPP4i（n=460）和 SGLT2i（n=101）治疗的患者，最小二乘均数（95%置信区间）eGFR 斜率分别为-1.91(-2.15，-1.67)和-1.12(-1.58，-0.67)mL/min/1.73 m/年，差异具有统计学意义（p=0.002）。敏感性分析结果加强了这一发现的稳健性。
本研究为 SGLT2i 在延缓 eGFR≥30 mL/min/1.73 m 的日本 2 型糖尿病成人肾功能下降方面优于 DPP4i 提供了潜在证据。
