Clinical and experimental nephrologyMar 16, 2026

Kidney health in Japanese people with type 2 diabetes and obesity: comparing two diabetes medicines

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Jun 27, 2026

Abstract

Essence

In obese Japanese patients with type 2 diabetes, SGLT2 inhibitors did not significantly outperform GLP-1 receptor agonists on renal outcomes.

Evidence

This retrospective propensity-matched study compared 89 patients per group after at least one year of therapy and found no significant difference in the renal composite outcome, with numerically smaller annual eGFR decline for SGLT2i (-1.6 vs -2.8 mL/min/1.73 m2/year, p=0.13).

Caveat

The study was retrospective with small matched groups, and the eGFR, blood pressure, and body-weight differences were not clearly tied to renal outcomes.

Simplified

INTRODUCTION: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1Ra) have shown renoprotective effects in type 2 diabetes (T2D). Our previous findings suggested superior renal outcomes with SGLT2i compared to GLP-1Ra, particularly due to greater reductions in blood pressure (BP). However, whether this benefit extends to obese patients remains unclear. This study compared renal outcomes between SGLT2i and GLP-1Ra in obese Japanese patients with T2D.

METHODS: This retrospective study included patients with T2D and body mass index ≥ 25 kg/mtreated with either SGLT2i (n = 439) or GLP-1Ra (n = 174) for over one year. Patients receiving both drugs were excluded. The renal composite outcome was defined as an annual decline in estimated glomerular filtration rate (eGFR) > 30%, progression of albuminuria category, or both. Propensity score matching was applied to balance baseline characteristics. 2

RESULTS: After matching (n = 89 per group), the incidence of renal events did not differ significantly between the two groups. The annual decline in eGFR tended to be smaller with SGLT2i than with GLP-1Ra (- 1.6 ± 3.5 vs. - 2.8 ± 5.8 mL/min/1.73 m/year, p = 0.13). SGLT2i-treated patients also showed greater reductions in systolic BP and body weight (BW) (- 5.0 ± 19.7 vs. - 1.1 ± 18.0 mmHg, p = 0.19; - 3.3 ± 4.6 vs. - 1.9 ± 4.9 kg, p = 0.05, respectively). 2

CONCLUSION: Among this population, the annual eGFR decline appeared numerically smaller with SGLT2i-tretament, without statistical significance. Greater BP and BW reductions were observed, though their impact on renal outcomes remains uncertain.