Comparing the effects of SGLT-2 inhibitors and other diabetes medications on kidney health

This study used real-world data to compare SGLT-2 inhibitors versus other medications for patients with type 2 diabetes (T2D). It found that SGLT-2 inhibitors led to lower kidney disease and better overall outcomes.

T2D is a condition in which the body cannot effectively lower the amount of glucose (sugar) in the blood. Over time, high glucose can damage small blood vessels and other delicate tissues including the kidneys. T2D is one of the leading causes of kidney failure. 

SGLT-2 inhibitors are a group of T2D medications that work by altering how the kidneys process glucose. Examples of these medications include dapagliflozin (Farxiga) and empagliflozin (Jardiance). SGLT-2 inhibitors prevent the kidneys from reabsorbing glucose from the waste liquid which becomes urine. Instead, the glucose passes out of the body. 

SGLT-2 inhibitors lower blood glucose levels. Multiple studies have found that SGLT-2 inhibitors reduce the risk of kidney damage. However, a carefully controlled clinical trial has different conditions from real-world treatment. Therefore the effects of SGLT-2 inhibitors compared to other diabetes drugs on kidney health are still not clear.

This study followed 45,016 patients who were starting treatment with SGLT-2 inhibitors. They were matched to an equal number of patients starting treatment with other diabetes medications (control group). Patients were followed for an average of 1.49 years.

167 patients experienced kidney failure. Of these, 53 occurred in the SGLT-2 inhibitors group and 114 in the control group. Patients taking SGLT-2 inhibitors had a 53% lower risk of kidney failure. There was a particularly strong benefit for patients with both T2D and obesity. Among patients with obesity, those taking SGLT-2 inhibitors had a 73% lower risk of kidney failure. The protective effect was also particularly pronounced for patients who already had decreased kidney function (eGFR below 90 ml/min/1.73 m2).

Patients taking SGLT-2 inhibitors had an 18% lower risk of death due to any cause over the course of the study.

This study found that patients taking SGLT-2 inhibitors have a lower risk of kidney failure and death compared to those taking other diabetes medications in a real-world practice.

SGLT-2 inhibitors have been less well studied in people of Asian descent. All data from this study came from South Korea’s national health service database. These results might be different in other populations. Also, this study analyzed medical records data. Information might have been incomplete.