Lee Yun Soo, Park Goeun, Lee Kyungho, Jang Hye Ryoun, Lee Jung Eun, Huh Wooseong, Jeon Junseok
Division of Nephrology, Department of Medicine, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of).
Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of).
BMJ Open Diabetes Res Care. 2025 Apr 5;13(2):e004876. doi: 10.1136/bmjdrc-2024-004876.
Recent post hoc analyses indicate that patients with normal or low body mass index (BMI) benefit from sodium-glucose cotransporter-2 (SGLT2) inhibitor use. We aimed to evaluate the effects of SGLT2 inhibitors on renal and patient outcomes in patients with diabetes and normal or low BMI.
This single-center retrospective cohort study included 5,842 adult patients with type 2 diabetes and BMI<23 kg/m from 2016 to 2020. Patients were divided into control and SGLT2 inhibitor groups and matched using propensity scores. The primary outcome was the annual change in the estimated glomerular filtration rate (eGFR). Secondary outcomes included change in BMI, a composite renal outcome (eGFR decline of ≥40% from baseline or end-stage kidney disease), all-cause mortality, and cardiovascular disease (CVD).
Overall, 648 patients were selected for propensity score matching, of whom 216 (33.3%) were receiving SGLT2 inhibitors. The mean age and eGFR were 61.6 years and 84.7 mL/min/1.73 m, respectively. The median urine albumin-to-creatinine ratio was 11.6 mg/gCr. The control group showed relatively unchanged eGFR over time, whereas the SGLT2 inhibitor group showed an increase in eGFR over time (0.0 vs +0.3 mL/min/1.73 m/year, p=0.0398). SGLT2 inhibitor use was associated with a lower risk of mortality (HR 0.171, 95% CI 0.041 to 0.718, p=0.0159) and composite renal outcome (HR 0.223, 95% CI 0.052 to 0.952; p=0.0426), but not with the risk of CVD.
SGLT2 inhibitor use may reduce the risk of eGFR decline and all-cause mortality even in low-risk patients with diabetes and normal or low BMI.
最近的事后分析表明，体重指数（BMI）正常或较低的患者可从使用钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂中获益。我们旨在评估SGLT2抑制剂对糖尿病且BMI正常或较低患者的肾脏及患者预后的影响。
这项单中心回顾性队列研究纳入了2016年至2020年期间5842例2型糖尿病且BMI<23kg/m²的成年患者。患者被分为对照组和SGLT2抑制剂组，并使用倾向得分进行匹配。主要结局是估计肾小球滤过率（eGFR）的年度变化。次要结局包括BMI变化、复合肾脏结局（eGFR较基线下降≥40%或终末期肾病）、全因死亡率和心血管疾病（CVD）。
总体而言，648例患者被选入倾向得分匹配，其中216例（33.3%）接受SGLT2抑制剂治疗。平均年龄和eGFR分别为61.6岁和84.7mL/min/1.73m²。尿白蛋白与肌酐比值的中位数为11.6mg/gCr。对照组的eGFR随时间相对无变化，而SGLT2抑制剂组的eGFR随时间增加（0.0 vs +0.3mL/min/1.73m²/年，p=0.0398）。使用SGLT2抑制剂与较低的死亡风险（HR 0.171，95%CI 0.041至0.718，p=0.0159）和复合肾脏结局风险相关（HR 0.223，95%CI 0.052至0.952；p=0.0426），但与CVD风险无关。
即使在糖尿病且BMI正常或较低的低风险患者中，使用SGLT2抑制剂也可能降低eGFR下降和全因死亡的风险。
