Sidra F N U, Agarwal Shubham, Lockhart Pastor Paola, Xie Donglu, Li Xilong, Lingvay Ildiko
Division of Endocrinology, Dept of Internal Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA.
Division of Endocrinology, Dept of Internal Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA.
J Diabetes Complications. 2025 Jan;39(1):108925. doi: 10.1016/j.jdiacomp.2024.108925. Epub 2024 Dec 4.
Atherosclerotic cardiovascular disease is the leading cause of death in people with type 2 diabetes (T2D) and chronic kidney disease (CKD) or end-stage kidney disease (ESKD). Glucagon-Like Peptide-1 receptor agonists (GLP-1RA) reduce cardiovascular events, improve glycemic control, promote weight loss, and slow progression of nephropathy. Despite these benefits and professional society treatment guidelines recommendations, GLP-1RAs remain under-utilized in people with advanced CKD and ESKD due to tolerability and safety concerns.
We conducted a retrospective cohort study comparing clinical outcomes and medication use details after initiating GLP-1RA or dipeptidyl-peptidase 4 inhibitor (DPP-4i) in people with T2D and advanced CKD or ESKD. Eligible patients were identified via electronic health record query with extraction of baseline demographics, vital signs, and laboratory values. A manual chart review was undertaken to confirm eligibility, medication use, and extract a detailed account of all side effects.
A total of 236 eligible patients (149 in the GLP-1RA group and 87 in the DPP-4i group) were identified. The average duration of treatment was 1036 (±909.9) and 1109 (±1090.9) days for GLP-1RA and DPP-4i, respectively. The average percentage weight loss from baseline to 36 months of treatment in the GLP-1RA group was -9.6 % (95 % CI, -11.3 to -7.8) versus -2.4 % (95 % CI, -5.4 to 0.5) in the DPP-4i group (estimated treatment difference (ETD) -7.1 (95 % CI, -10.6 to -3.7) percentage-points, p < 0.001). The change in HbA1c from baseline to 36 months of treatment was significantly greater in the GLP-1RA (-1.0 %) compared with the DPP-4i group (0.2 %) (ETD -1.2 (95 % CI, -2.1 to -0.3) percentage-points, p = 0.04).
In patients with T2D and advanced CKD or ESKD, treatment with GLP-1RAs in a real-world setting had long treatment persistence, and compared to DPP-4is, was associated with greater weight loss and glycemic improvement.
动脉粥样硬化性心血管疾病是2型糖尿病（T2D）合并慢性肾脏病（CKD）或终末期肾病（ESKD）患者的主要死因。胰高血糖素样肽-1受体激动剂（GLP-1RA）可减少心血管事件、改善血糖控制、促进体重减轻并减缓肾病进展。尽管有这些益处且专业学会的治疗指南也有推荐，但由于耐受性和安全性问题，GLP-1RA在晚期CKD和ESKD患者中的使用仍不足。
我们进行了一项回顾性队列研究，比较了T2D合并晚期CKD或ESKD患者开始使用GLP-1RA或二肽基肽酶4抑制剂（DPP-4i）后的临床结局和用药细节。通过电子健康记录查询确定符合条件的患者，并提取基线人口统计学、生命体征和实验室值。进行人工病历审查以确认资格、用药情况，并详细记录所有副作用。
共确定了236例符合条件的患者（GLP-1RA组149例，DPP-4i组87例）。GLP-1RA组和DPP-4i组的平均治疗持续时间分别为1036（±909.9）天和1109（±1090.9）天。GLP-1RA组从基线到治疗36个月的平均体重减轻百分比为-9.6%（95%CI，-11.3至-7.8），而DPP-4i组为-2.4%（95%CI，-5.4至0.5）（估计治疗差异（ETD）-7.1（95%CI，-10.6至-3.7）个百分点，p<0.001）。与DPP-4i组（0.2%）相比，GLP-1RA组从基线到治疗36个月时HbA1c的变化显著更大（-1.0%）（ETD -1.2（95%CI，-2.1至-0.3）个百分点，p = 0.04）。
在T2D合并晚期CKD或ESKD患者中，在现实环境中使用GLP-1RA治疗的持续时间较长，与DPP-4i相比，体重减轻更多，血糖改善更明显。
