Temporal Changes in SGLT2 Inhibitor and GLP-1 Receptor Agonist Use in Patients with Chronic Kidney Disease and Type 2 Diabetes, 2012–2023: A US Cohort Study

Dec 9, 2025Diabetes therapy : research, treatment and education of diabetes and related disorders

Changes Over Time in Use of Two Diabetes Medicines in US Patients with Kidney Disease and Type 2 Diabetes, 2012-2023

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Abstract

New users of SGLT2 inhibitors and GLP-1 receptor agonists in a later period (9 July 2021-30 September 2023) were older and had more severe chronic kidney disease compared to earlier users.

Later period new users had better metabolic control despite using less intensive type 2 diabetes medication.
SGLT2 inhibitor new users more frequently had no prior type 2 diabetes therapy before treatment initiation.
There was a higher prevalence of congestive heart failure among later period SGLT2 inhibitor new users.
GLP-1 receptor agonist new users showed increased use of SGLT2 inhibitors and decreased use of insulin.

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INTRODUCTION: Type 2 diabetes is a leading cause of chronic kidney disease (CKD). Individuals with both conditions have increased risk of poor cardiorenal outcomes and mortality. The rapidly evolving landscape for CKD-protective therapies in type 2 diabetes currently includes sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA), both of which demonstrate cardiorenal outcome benefits. As part of the FOUNTAIN platform (ClinicalTrials.gov ID: NCT05526157; EUPAS ID: EUPAS48148), this study aimed to better understand changes in patient characteristics and treatment patterns corresponding with updates to clinical guideline recommendations and drug labeling and the emergence of new CKD-protective therapies such as finerenone in the US in 2021-2022.

METHODS: An observational real-world data study assessed patient characteristics and drug utilization in separate SGLT2i and GLP-1 RA new-user cohorts of adults with CKD and type 2 diabetes in an earlier (1 January 2012-30 June 2021) and a later (9 July 2021-30 September 2023) period using Optum's de-identified ClinformaticsData Mart Database (OptumCDM). ® ®

RESULTS: Compared with the earlier period new users, later period new users in both cohorts were older, had more severe CKD, used less intensive type 2 diabetes medication, and had better metabolic control; SGLT2i new users more frequently had no type 2 diabetes therapy before the index date and greater congestive heart failure prevalence; and GLP-1 RA new users had increased SGLT2i use and decreased insulin use.

CONCLUSIONS: These findings inform and contextualize future studies assessing cardiorenal outcomes for these and additional treatments, including finerenone, for individuals with CKD and type 2 diabetes.

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Temporal Changes in SGLT2 Inhibitor and GLP-1 Receptor Agonist Use in Patients with Chronic Kidney Disease and Type 2 Diabetes, 2012–2023: A US Cohort Study

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