Comparative effectiveness of sodium‐glucose cotransporter‐2 inhibitors versus glucagon‐like peptide‐1 receptor agonists in patients with type 2 diabetes and mild/moderate chronic kidney disease

Jan 8, 2024Diabetes, obesity & metabolism

Comparing sodium-glucose transport inhibitors and glucagon-like peptide-1 drugs in type 2 diabetes patients with mild to moderate kidney disease

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Abstract

Patients with type 2 diabetes and chronic kidney disease treated with SGLT-2 inhibitors experienced a 14% lower risk of non-fatal myocardial infarction or stroke compared to those treated with GLP-1 receptor agonists.

SGLT-2 inhibitors were associated with a hazard ratio of 0.86 for non-fatal myocardial infarction or stroke.
The study examined patients with type 2 diabetes and varying stages of chronic kidney disease.
Data were derived from commercially insured adult patients in the United States between 2003 and 2021.
Results indicate a significant difference in cardiovascular outcomes between the two treatment groups.

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AIM: To determine the comparative effectiveness regarding major cardiovascular events of glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD).

MATERIALS AND METHODS: We assembled a cohort of commercially insured adult patients with T2DM in the United States (derived from Optum Clinformatics DataMart 2003-2021) who were new users of GLP-1 receptor agonists or SGLT-2 inhibitors. We compared risks of non-fatal myocardial infarction or stroke in patients with and without CKD, and further categorized by CKD stage: stages G1 or G2 [estimated glomerular filtration rate (eGFR) ≥60 ml/min] and A2 (urine albumin to creatinine ratio 30 to <300 mg/g) or A3 (urine albumin to creatinine ratio ≥300 mg/g), stage G3a (eGFR 45 to <60 ml/min/1.73 m) and stage G3b (eGFR 30 to <45 ml/min/1.73 m). We used proportional hazards regression after inverse probability of treatment weighting to compute hazard ratios and 95% confidence intervals. 2 2

RESULTS: After accounting for the probability of treatment, patients with T2DM and CKD treated with SGLT-2 inhibitors experienced a 14% lower risk of non-fatal myocardial infarction or stroke (hazard ratio 0.86, 95% confidence interval 0.78-0.94) relative to those treated with GLP-1 receptor agonists.

CONCLUSIONS: Recognizing the potential for residual confounding, selection bias and immortal time bias, commercially insured patients in the United States with T2DM and CKD treated with SGLT-2 inhibitors experienced significantly lower risks of non-fatal myocardial infarction or stroke relative to those treated with GLP-1 receptor agonists.

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Comparative effectiveness of sodium‐glucose cotransporter‐2 inhibitors versus glucagon‐like peptide‐1 receptor agonists in patients with type 2 diabetes and mild/moderate chronic kidney disease

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