Early biomarkers of diabetic kidney disease. A focus on albuminuria and a new combination of antidiabetic agents

Jun 14, 2020International journal of clinical practice

Early signs of diabetic kidney disease focusing on protein in urine and a new combination of diabetes medicines

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Abstract

At 26 weeks, a significant reduction in urinary albumin-to-creatinine ratio (UACR) of 15.14 mg/g was observed in patients treated with a combination of sodium-glucose cotransporter type 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1ra).

Combination therapy with SGLT2i and GLP1ra led to notable decreases in glycated hemoglobin (HbA1c) by 1.16% and body weight by 5.17 kg.
Systolic blood pressure decreased by 8.13 mmHg over the study period.
Patients with an initial urinary albumin-to-creatinine ratio (UACR) of ≥30 mg/g experienced a more pronounced reduction of 63.18 mg/g.
The most significant UACR reduction was observed when SGLT2i was added to GLP1ra therapy, with a decrease of 116.7 mg/g.
Estimated glomerular filtration rate (eGFR) remained stable throughout the study.

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AIMS: We aimed to determine the efficacy and safety of sodium-glucose cotransporter type 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists to prevent worsening urinary albumin-to-creatinine ratio as an early biomarker of diabetes kidney disease.

METHODS: A total of 178 patients with type 2 diabetes and obesity received combination treatment with SGLT2i added to GLP1ra (n = 76), GLP1ra added to SGLT2i (n = 50) or GLP1ra plus SGLT2i from start (n = 52), according to investigators´ best clinical judgement. Major outcomes assessed at 26 weeks were changes in urine albumintocreatinine-ratio (UACR), estimated glomerular filtration rate (eGFR), glycated haemoglobin, body weight and systolic blood pressure.

RESULTS: All patients (58.6% men, mean age 61.9 ± 10.0 years) completed the study. Baseline HbA1c, weight and eGFR levels were 8.2 ± 0.9%, 109.9 ± 19 kg and 83.3 ± 19.6 mL/min/m, respectively. At 26 weeks, we found significant reductions in HbA1c (1.16%), weight (5.17 kg) and systolic blood pressure (8.13 mmHg). The reduction in UACR was 15.14 mg/g (95% CI 8.50-22.4) (-24.6 ± 64.7%), which was greatest in the group of patients with SGLT2i added on to GLP1ra therapy (116.7 mg/g; 95% CI: 54-296.5 mg/g; P < .001. Patients with urinary albumin-to-creatinine ratio ≥30 mg/g, showed a higher declines (63.18 mg/g [95% CI 44.5-104.99]) (-56 ± 65.9%). The greatest reduction in urinary albumin-to-creatinine ratio was obtained when SGLT2i was added to GLP1ra (116.7 mg/g). The eGFR did not significantly change along the study period. 2

CONCLUSION: Our results show the beneficial effect of GLP1ra and SGLT2i combination therapy on early biomarkers of diabetes kidney disease such as albuminuria and in other significant outcomes for diabetes control.

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Early biomarkers of diabetic kidney disease. A focus on albuminuria and a new combination of antidiabetic agents

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