Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Front Endocrinol (Lausanne). 2024 Jun 27;15:1329945. doi: 10.3389/fendo.2024.1329945. eCollection 2024.
There is a lack of real-world evidence regarding the impact of concomitant metformin and renin-angiotensin system inhibitors (RASis) on sodium-glucose cotransporter-2 inhibitor (SGLT2i)-associated kidney outcomes. This study was aimed to investigate whether SGLT2i-associated kidney outcomes were modified by the concomitant use of metformin or RASis in patients with type 2 diabetes.
SGLT2i users were identified from three electronic health record databases during May 2016 and December 2017 and categorized into those with and without concomitant use of metformin or RASis. Propensity score matching was performed to minimize baseline differences between groups. Study outcomes were mean estimated glomerular filtration rate (eGFR) change and time to 30%, 40%, and 50% eGFR reductions. A meta-analysis was performed to combine the estimates across databases.
After matching, there were 6,625 and 3,260 SGLT2i users with and without metformin, and 6,654 and 2,746 SGLT2i users with and without RASis, respectively. The eGFR dip was similar in SGLT2i users with and without metformin therapy, but was greater in SGLT2i users with RASis compared to those without RASis. Neither metformin nor RASi use had a significant effect on SGLT2i-associated eGFR reductions, as evidenced by the hazard ratios (95% CIs) of 30% eGFR reductions for SGLT2is with versus without metformin/RASis, namely 1.02 (0.87-1.20)/1.09 (0.92-1.31). Such findings were also observed in the outcomes of 40% and 50% eGFR reductions.
Using metformin or RASis did not modify SGLT2i-associated kidney outcomes in type 2 diabetes.
关于同时使用二甲双胍和肾素-血管紧张素系统抑制剂（RASi）对钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）相关肾脏结局的影响，目前缺乏真实世界证据。本研究旨在探讨 2 型糖尿病患者同时使用 SGLT2i 和二甲双胍或 RASi 是否会改变 SGLT2i 相关的肾脏结局。
我们从三个电子健康记录数据库中于 2016 年 5 月至 2017 年 12 月期间确定了 SGLT2i 使用者，并将其分为同时使用和不使用二甲双胍或 RASi 的两组。通过倾向评分匹配来最小化两组间的基线差异。研究结果为平均估算肾小球滤过率（eGFR）变化和达到 eGFR 降低 30%、40%和 50%的时间。对数据库进行了汇总分析。
匹配后，SGLT2i 使用者中有 6625 人和 3260 人分别同时使用和不使用二甲双胍，SGLT2i 使用者中有 6654 人和 2746 人分别同时使用和不使用 RASi。SGLT2i 使用者中同时使用和不使用二甲双胍的 eGFR 下降情况相似，但同时使用 RASi 的患者比不使用 RASi 的患者 eGFR 下降更大。使用二甲双胍或 RASi 对 SGLT2i 相关的 eGFR 下降均无显著影响，这一点从 SGLT2i 与不使用二甲双胍/ RASi 相比，eGFR 降低 30%的风险比（95%置信区间）（即 1.02[0.87-1.20]/1.09[0.92-1.31]）中可以看出。在 eGFR 降低 40%和 50%的结果中也观察到了同样的发现。
在 2 型糖尿病患者中，使用二甲双胍或 RASi 并不改变 SGLT2i 相关的肾脏结局。
