Diabetes, obesity & metabolismMay 4, 2019

Identifying groups of type 2 diabetes patients with different kidney function outcomes when treated with SGLT2 inhibitors versus DPP-4 inhibitors using machine learning

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Updated Feb 27, 2026

Abstract

The proportion of patients with was significantly greater in the SGLT2 inhibitor group (odds ratio 1.27; P = 0.01).

SGLT2 inhibitors were linked to a greater likelihood of renal function preservation compared to DPP-4 inhibitors in patients with type 2 diabetes.
Four specific patient subgroups showed enhanced renal function preservation benefits from SGLT2 inhibitors.
These subgroups included patients without hyperlipidaemia and with eGFR ≥79 mL/min/1.73 m, and those with diabetes duration ≤1.2 years.
Additional profiles included patients with eGFR ≥75 mL/min/1.73 m using antithrombotic agents, and those with hemoglobin ≤13.4 g/dL and LDL cholesterol ≥95.1 mg/dL.
Glycemic control was comparable between patients taking SGLT2 inhibitors and those on DPP-4 inhibitors.

Simplified

AIMS: To investigate the effects of sodium-glucose co-transporter-2 (SGLT2) inhibitors vs. dipeptidyl peptidase-4 (DPP-4) inhibitors on (RFP) using real-world data of patients with type 2 diabetes in Japan, and to identify which subgroups of patients obtained greater RFP benefits with SGLT2 inhibitors vs. DPP-4 inhibitors.

METHODS: We retrospectively analysed claims data recorded in the Medical Data Vision database in Japan of patients with type 2 diabetes (aged ≥18 years) prescribed any SGLT2 inhibitor or any DPP-4 inhibitor between May 2014 and September 2016 (identification period), in whom estimated glomerular filtration rate (eGFR) was measured at least twice (baseline, up to 6 months before the index date; follow-up, 9 to 15 months after the index date) with continuous treatment until the follow-up eGFR. The endpoint was the percentage of patients with RFP, defined as no change or an increase in eGFR from baseline to follow-up. A proprietary supervised learning algorithm (Q-Finder; Quinten, Paris, France) was used to identify the profiles of patients with an additional RFP benefit of SGLT2 inhibitors vs. DPP-4 inhibitors.

RESULTS: Data were available for 990 patients prescribed SGLT2 inhibitors and 4257 prescribed DPP-4 inhibitors. The proportion of patients with RFP was significantly greater in the SGLT2 inhibitor group (odds ratio 1.27; P = 0.01). The Q-Finder algorithm identified four clinically relevant subgroups showing superior RFP with SGLT2 inhibitors (P < 0.1): no hyperlipidaemia and eGFR ≥79 mL/min/1.73 m; eGFR ≥79 mL/min/1.73 mand diabetes duration ≤1.2 years; eGFR ≥75 mL/min/1.73 mand use of antithrombotic agents; and haemoglobin ≤13.4 g/dL and LDL cholesterol ≥95.1 mg/dL. In each profile, glycaemic control was similar in the two groups. 2 2 2

CONCLUSION: SGLT2 inhibitors were associated with more favourable RFP vs. DPP-4 inhibitors in patients with certain profiles in real-world settings in Japan.

Key numbers

1.27

Higher Odds of

Odds ratio for in SGLT2 vs. DPP-4 inhibitor groups.

Patient Profiles Identified

Number of clinically relevant profiles showing superior with SGLT2 inhibitors.

42%

Proportion of Patients with

Percentage of patients in the SGLT2 inhibitor group achieving .

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Funding

Competing interests

F.L.Z. is an employee of Sanofi, USA. H.W. has received honoraria for scientific lectures from MSD K.K., Eli Lilly Japan K.K., Takeda Pharmaceutical Co., Ltd, Novartis Pharma K.K., Sumitomo Dainippon Pharma Co., Ltd, Sanofi K.K. and Daiichi Sankyo Company Ltd, and research funds from MSD K.K., Eli Lilly Japan K.K., Takeda Pharmaceutical Co., Ltd, Kowa Pharmaceutical Co., Ltd, Mochida Pharmaceutical Co. Ltd, Sanwa Kagaku Kenkyusho Co., Ltd, Novo Nordisk Pharma Ltd, Kissei Pharmaceutical Co., Ltd, Novartis Pharma K.K., Nippon Boehringer Ingelheim Co., Ltd, AstraZeneca K.K., Astellas Pharma Inc., Mitsubishi Tanabe Pharma Corporation, Sumitomo Dainippon Pharma Co., Ltd, Abbott Japan Co., Ltd, Sanofi K.K., Pfizer Japan Inc. and Daiichi Sankyo Company Ltd. Y.T. and Y.S. are employees of Sanofi K.K., Japan. M.B., D.Kang and C.E. are employees of Quinten, France. H.M. has received honoraria for scientific lectures from MSD K.K., Nippon Boehringer Ingelheim Co., Ltd, Astellas Pharma Inc., Ono Pharmaceutical Co., Ltd, Mitsubishi Tanabe Pharma Corporation, Sanofi K.K., Taisho Toyama Pharmaceutical Co., Ltd, Takeda Pharmaceutical Co., Ltd, Kowa Pharmaceutical Co., Ltd, Daiichi Sankyo Company Ltd, AstraZeneca K.K., Sanwa Kagaku Kenkyusho Co., Ltd, Novartis Pharma K.K. and Eli Lilly Japan K.K., research funds from Astellas Pharma Inc. and AstraZeneca K.K., and grants from Takeda Pharmaceutical Co., Ltd, Astellas Pharma Inc., MSD K.K., Teijin Pharma Ltd, Nippon Boehringer Ingelheim Co., Ltd, Kyowa Hakko Kirin Co., Ltd, Taisho Toyama Pharmaceutical Co., Ltd, Kowa Pharmaceutical Co., Ltd, Ono Pharmaceutical Co., Ltd, Daiichi Sankyo Company Ltd, Sanofi K.K., Mitsubishi Tanabe Pharma Corporation, Shionogi & Co., Ltd, Chugai Pharmaceutical Co., Ltd, Sunstar Inc., Otsuka Pharmaceutical Co., Ltd, Sanwa Kagaku Kenkyusho Co., Ltd, Sumitomo Dainippon Pharma Co., Ltd, Eisai Co., Ltd, Pfizer Japan Inc., Novo Nordisk Pharma Ltd, Mochida Pharmaceutical Co. Ltd, Novartis Pharma K.K. and Bristol‐Myers Squibb. D.Koya has received honoraria for scientific lectures from Astellas Pharma Inc., AstraZeneca K.K., MSD K.K., Ono Pharmaceutical Co., Ltd, Kyowa Hakko Kirin Co., Ltd, Taisho Toyama Pharmaceutical Co., Ltd, Taisho Pharmaceutical Co., Ltd, Takeda Pharmaceutical Co., Ltd, Mitsubishi Tanabe Pharma Corporation, Eli Lilly Japan K.K., Nippon Boehringer Ingelheim Co., Ltd, research funds from Sanwa Kagaku Kenkyusho Co., Ltd, Site Support Institute Co., Ltd, Mitsubishi Tanabe Pharma Corporation, and Morinaga & Co., Ltd, grants from Astellas Pharma Inc., AstraZeneca K.K., Ono Pharmaceutical Co., Ltd, Kissei Pharmaceutical Co., Ltd, Kyowa Hakko Kirin Co., Ltd, Kowa Pharmaceutical Co., Ltd, Sanofi K.K., Johnson & Johnson K.K., Daiichi Sankyo Company Ltd, Taisho Toyama Pharmaceutical Co., Ltd, Sumitomo Dainippon Pharma Co., Ltd, Takeda Pharmaceutical Co., Ltd, Mitsubishi Tanabe Pharma Corporation, Japan Tobacco Inc., Novo Nordisk Pharma Ltd, Bayer Yakuhin, Ltd and Pfizer Japan Inc., and courses endowed by Ono Pharmaceutical Co., Ltd, Kyowa Hakko Kirin Co., Ltd, Taisho Toyama Pharmaceutical Co., Ltd, Mitsubishi Tanabe Pharma Corporation and Nippon Boehringer Ingelheim Co., Ltd.

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Identifying groups of type 2 diabetes patients with different kidney function outcomes when treated with SGLT2 inhibitors versus DPP-4 inhibitors using machine learning

Abstract

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Competing interests

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Abstract

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Competing interests

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