Diabetes & metabolism journalMay 14, 2025

New Evidence and Use of SGLT2 Inhibitors and GLP-1 Receptor Agonists for Kidney Disease in Diabetes

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Jan 20, 2026

Abstract

SGLT2 inhibitors and GLP-1 receptor agonists may reshape diabetic kidney disease management, providing distinct cardiorenal benefits.

Diabetic kidney disease (DKD) significantly increases the risk of end-stage kidney disease and cardiovascular mortality.
Conventional therapies, including certain inhibitors, leave substantial residual risk in DKD patients.
SGLT2 inhibitors may mitigate glomerular hyperfiltration and lower heart failure risk.
GLP-1 receptor agonists are associated with reductions in albuminuria and atherosclerotic cardiovascular events.
Indirect comparisons suggest SGLT2 inhibitors could offer greater protection against kidney function decline, though direct trials are needed.
Combination therapy may enhance treatment efficacy, but further studies are required to determine optimal strategies.

Simplified

Diabetic kidney disease (DKD) is a leading cause of end-stage kidney disease and significantly increases cardiovascular risk and mortality. Despite conventional therapies, including renin-angiotensin-aldosterone system inhibitors, substantial residual risk remains. The emergence of sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists has reshaped DKD management. Beyond glycemic control, these agents provide distinct and complementary cardiorenal benefits through mechanisms such as hemodynamic modulation, anti-inflammatory effects, and metabolic adaptations. Landmark trials, including CREDENCE, DAPA-CKD, EMPA-KIDNEY, and FLOW, have demonstrated their efficacy in preserving kidney function and reducing adverse outcomes. SGLT2 inhibitors appear more effective in mitigating glomerular hyperfiltration and lowering heart failure risk, whereas GLP-1 receptor agonists are particularly beneficial in reducing albuminuria and atherosclerotic cardiovascular events. Although indirect comparisons suggest that SGLT2 inhibitors may offer greater protection against kidney function decline, direct head-to-head trials are lacking. Combination therapy holds promise, however further studies are needed to define optimal treatment strategies. This review synthesizes current evidence, evaluates comparative effectiveness, and outlines future directions in DKD management, emphasizing precision medicine approaches to enhance clinical outcomes. The integration of these therapies represents a paradigm shift in diabetes care, expanding treatment options for people with diabetes mellitus at risk of kidney failure.

Key numbers

30%

Reduction in Kidney Events

Risk reduction in kidney events from CREDENCE trial

39%

Risk Reduction in Kidney Failure

Risk reduction in DAPA-CKD trial

24%

Reduction in Kidney Failure Risk

Risk reduction in FLOW trial

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Funding

Competing interests

CONFLICTS OF INTEREST . No potential conflict of interest relevant to this article was reported.

PubMed

New Evidence and Use of SGLT2 Inhibitors and GLP-1 Receptor Agonists for Kidney Disease in Diabetes

Abstract

Key numbers

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Competing interests

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Abstract

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Full Text

Funding

Competing interests

Related papers

You found one interesting study. We’ll send the next 7.

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Recent issues from the glp-1 therapies brief