Lee Yen-Chieh, Wu Li-Chiu, Wu Vin-Cent, Chang Chia-Hsuin
Department of Family and Community Medicine, Cathay General Hospital, National Taiwan University, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
Am J Kidney Dis. 2025 Apr 29. doi: 10.1053/j.ajkd.2025.03.016.
RATIONALE & OBJECTIVE: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium/glucose cotransporter 2 (SGLT2) inhibitors improve cardiovascular, kidney, and survival outcomes in patients with type 2 diabetes; however, the comparative effectiveness of these drugs in a real-world setting remains unclear.
Retrospective cohort study.
SETTING & PARTICIPANTS: 79,047 patients with type 2 diabetes and an estimated glomerular filtration rate<60mL/min/1.73m in the Taiwan National Health Insurance Research Database between 2016 and 2021.
Treatment with GLP-1RAs or SGLT2 inhibitors.
Initiation of kidney replacement therapy (KRT) and all-cause mortality.
Propensity score matching was performed to balance baseline characteristics between the groups. Cox proportional hazards models were used to estimate HRs and 95% CIs for each outcome using an intention-to-treat approach.
14,182 (7,091 initiating GLP-1RAs and 7,091 initiating SGLT2 inhibitors) individuals among the original cohort of 79,047 were included in the propensity score-matched analysis. With a median follow-up duration of 2.5 years, people initiating GLP-1RAs had a higher risk of requiring KRT than those initiating SGLT2 inhibitors (HR, 1.39; 95% CI, 1.19-1.63). Although tests of interaction did not have statistically significant findings, stratified analyses suggested possibly greater differences between the 2 drugs among patients with an estimated glomerular filtration rate<45mL/min/1.73m or a urine albumin-creatinine ratio>300mg/g. Overall mortality did not differ between treatment groups.
Nonrandomized treatment selection.
Patients receiving SGLT2 inhibitors exhibited lower rates of progression to KRT than those receiving GLP-1RAs. These findings may inform the choice of these therapies in the setting of chronic kidney disease and type 2 diabetes.
PLAIN-LANGUAGE SUMMARY: Chronic kidney disease is a major complication of type 2 diabetes that often leads to kidney failure and increased mortality. This study aimed to compare the effectiveness of 2 drug classes, glucagon-like peptide-1 receptor agonists and sodium/glucose cotransporter 2 inhibitors, in preventing kidney failure and death in patients with type 2 diabetes and chronic kidney disease. Using a nationwide health database in Taiwan, we applied rigorous statistical methods to balance differences between treatment groups and analyze outcomes. Our findings demonstrated that sodium/glucose cotransporter 2 inhibitors might be more effective than glucagon-like peptide-1 receptor agonists in reducing the risk of kidney failure, and possibly even more so in patients with advanced kidney disease. These results may inform the choice of these agents in the setting of chronic kidney disease and diabetes.
胰高血糖素样肽-1受体激动剂（GLP-1RAs）和钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂可改善2型糖尿病患者的心血管、肾脏状况并提高生存率；然而，这些药物在现实环境中的相对疗效仍不明确。
回顾性队列研究。
2016年至2021年期间，台湾国民健康保险研究数据库中79047例2型糖尿病患者，估计肾小球滤过率<60mL/min/1.73m²。
接受GLP-1RAs或SGLT2抑制剂治疗。
开始肾脏替代治疗（KRT）和全因死亡率。
采用倾向评分匹配法平衡组间基线特征。使用Cox比例风险模型，采用意向性分析方法估计各结局的风险比（HR）和95%置信区间（CI）。
在最初的79047名队列中，14182人（7091人开始使用GLP-1RAs，7091人开始使用SGLT2抑制剂）纳入倾向评分匹配分析。中位随访时间为2.5年，开始使用GLP-1RAs的患者开始KRT的风险高于开始使用SGLT2抑制剂的患者（HR，1.39；95%CI，1.19-1.63）。尽管交互作用检验未得出具有统计学意义的结果，但分层分析表明，在估计肾小球滤过率<45mL/min/1.73m²或尿白蛋白肌酐比值>300mg/g的患者中，这两种药物之间可能存在更大差异。治疗组之间的总体死亡率没有差异。
非随机治疗选择。
接受SGLT2抑制剂治疗的患者进展至KRT的发生率低于接受GLP-1RAs治疗的患者。这些发现可能为慢性肾脏病和2型糖尿病患者选择这些治疗方法提供参考。
慢性肾脏病是2型糖尿病的主要并发症，常导致肾衰竭和死亡率增加。本研究旨在比较两类药物，即胰高血糖素样肽-1受体激动剂和钠-葡萄糖协同转运蛋白2抑制剂，在预防2型糖尿病和慢性肾脏病患者肾衰竭和死亡方面的有效性。我们利用台湾的全国健康数据库，应用严格的统计方法平衡治疗组之间的差异并分析结局。我们的研究结果表明，钠-葡萄糖协同转运蛋白2抑制剂在降低肾衰竭风险方面可能比胰高血糖素样肽-1受体激动剂更有效，在晚期肾脏病患者中可能更是如此。这些结果可能为慢性肾脏病和糖尿病患者选择这些药物提供参考。
