Renoprotective effects of combination treatment with sodium-glucose cotransporter inhibitors and GLP-1 receptor agonists in patients with type 2 diabetes mellitus according to preceding medication.

Diabetes & vascular disease research Pub Date : 2023-11-01 DOI:10.1177/14791641231222837

Kazuo Kobayashi, Masao Toyoda, Atsuhito Tone, Daiji Kawanami, Daisuke Suzuki, Daisuke Tsuriya, Hideo Machimura, Hidetoshi Shimura, Hiroshi Takeda, Hisashi Yokomizo, Kei Takeshita, Keiichi Chin, Keizo Kanasaki, Masaaki Miyauchi, Masuo Saburi, Miwa Morita, Miwako Yomota, Moritsugu Kimura, Nobuo Hatori, Shinichi Nakajima, Shun Ito, Shunichiro Tsukamoto, Takashi Murata, Takaya Matsushita, Takayuki Furuki, Takuya Hashimoto, Tomoya Umezono, Yoshimi Muta, Yuichi Takashi, Kouichi Tamura

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Abstract

Aims: Combination therapy with sodium-glucose cotransporter inhibitors (SGLT2is) and GLP-1 receptor agonists (GLP1Ras) is now of interest in clinical practice. The present study evaluated the effects of the preceding drug type on the renal outcome in clinical practice.

Methods: We retrospectively extracted type 2 diabetes mellitus patients who had received both SGLT2i and GLP1Ra treatment for at least 1 year. A total of 331 patients in the GLP1Ra-preceding group and 312 patients in the SGLT2i-preceding group were ultimately analyzed. Either progression of the albuminuria status and/or a ≥30% decrease in the eGFR was set as the primary renal composite outcome. The analysis using propensity score with inverse probability weighting was performed for the outcome.

Results: The incidences of the renal composite outcome in the SGLT2i- and GLP1Ra-preceding groups were 28% and 25%, respectively, with an odds ratio [95% confidence interval] of 1.14 [0.75, 1.73] (p = .54). A logistic regression analysis showed that the mean arterial pressure (MAP) at baseline, the logarithmic value of the urine albumin-to-creatinine ratio at baseline, and the change in MAP were independent factors influencing the renal composite outcome.

Conclusion: With combination therapy of SGLT2i and GLP1Ra, the preceding drug did not affect the renal outcome.

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钠-葡萄糖共转运体抑制剂和 GLP-1 受体激动剂联合治疗对 2 型糖尿病患者肾脏的保护作用（根据之前的用药情况而定）。

目的：钠-葡萄糖共转运体抑制剂（SGLT2is）和GLP-1受体激动剂（GLP1Ras）的联合治疗目前在临床实践中备受关注。本研究评估了临床实践中前一种药物类型对肾功能结果的影响：我们回顾性地提取了接受 SGLT2i 和 GLP1Ra 治疗至少 1 年的 2 型糖尿病患者。最终分析了331名GLP1Ra治疗前组患者和312名SGLT2i治疗前组患者。白蛋白尿状态的恶化和/或 eGFR 下降≥30% 被设定为主要的肾脏综合结局。结果显示，白蛋白尿状态恶化和/或 eGFR 下降≥30%为主要的肾脏综合结果：结果：SGLT2i-和GLP1Ra先导组的肾脏综合结果发生率分别为28%和25%，几率比[95%置信区间]为1.14[0.75, 1.73]（P = .54）。逻辑回归分析显示，基线平均动脉压（MAP）、基线尿白蛋白与肌酐比值的对数值以及MAP的变化是影响肾脏综合结果的独立因素：结论：SGLT2i 和 GLP1Ra 联合治疗时，前一种药物不会影响肾脏预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Diabetes & vascular disease research

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