Prospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Feb 15, 2025; 16(2): 98552
Published online Feb 15, 2025. doi: 10.4239/wjd.v16.i2.98552
Efficacy of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists on proteinuria and weight in a diabetes cohort
Di-Fei Lu, Rui Zheng, Ang Li, Jun-Qing Zhang
Di-Fei Lu, Ang Li, Jun-Qing Zhang, Department of Endocrinology, Peking University First Hospital, Beijing 100034, China
Rui Zheng, iHealth Labs China Co., Ltd., Beijing 100034, China
Author contributions: Lu DF and Zhang JQ designed the study protocol; Li A, Lu DF, and Zhang JQ collected the data; Zheng R performed the data analysis; Lu DF wrote the manuscript; and all the authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Peking University First Hospital Institutional Review Board (No. 2018104).
Clinical trial registration statement: All patients enrolled in the study were treated in accordance with clinical guidelines and were not influenced by study enrollment; thus, clinical trial registration was exempt.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare that they do not have conflicts of interest. None of the authors has received fees for serving as a speaker or receiving research funding from any company.
Data sharing statement: Original data are available upon request to the corresponding author. All data involving enrolled patients were anonymized.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun-Qing Zhang, MD, PhD, Chief Doctor, Department of Endocrinology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China. junqing.zhang@pkufh.com
Received: June 29, 2024
Revised: October 11, 2024
Accepted: December 2, 2024
Published online: February 15, 2025
Processing time: 184 Days and 8.2 Hours
Abstract
BACKGROUND

With accumulating evidence showing a benefit in the renal and cardiovascular systems, diabetes guidelines recommend that patients with diabetes and chronic kidney disease (CKD) be treated with sodium-glucose cotransporter-2 inhibitor (SGLT2i) and/or glucagon like peptide-1 receptor agonists (GLP-1RAs) for renal protection. The real-world efficacy of the two medications on the urinary albumin-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) remains to be explored.

AIM

To evaluate the SGLT2i and GLP-1RA application rates and UACR alterations after intervention in a real-world cohort of patients with diabetes.

METHODS

A cohort of 5482 patients with type 2 diabetes were enrolled and followed up at the Integrated Care Clinic for Diabetes of Peking University First Hospital for at least 6 months. Propensity score matching was performed, and patients who were not recommended for GLP-1RA or SGLT2i with comparable sex categories and ages were assigned to the control group at a 1:2 ratio. Blood glucose, body weight, UACR and eGFR were evaluated after 6 months of treatment in real-world clinical practice.

RESULTS

A total of 139 (2.54%) patients started GLP-1RA, and 387 (7.06%) received SGLT2i. After 6 months, the variations in fasting blood glucose, prandial blood glucose, and glycosylated hemoglobin between the GLP-1RA group and the SGLT2i and control groups were not significantly different. UACR showed a tendency toward a greater reduction compared with the control group, although this difference was not statistically significant (GLP-1RA vs control, -2.20 vs 30.16 mg/g, P = 0.812; SGLT2i vs control, -20.61 vs 12.01 mg/g, P = 0.327); eGFR alteration also showed no significant differences. Significant weight loss was observed in the GLP-1RA group compared with the control group (GLP-1RA vs control, -0.90 vs 0.27 kg, P < 0.001), as well as in the SGLT2i group (SGLT2i vs control, -0.59 vs -0.03 kg, P = 0.010).

CONCLUSION

Compared with patients who received other glucose-lowering drugs, patients receiving SGLT2i or GLP-1RAs presented significant weight loss, a decreasing trend in UACR and comparable glucose-lowering effects in real-world settings.

Keywords: Type 2 diabetes; Chronic kidney disease; Body weight; Sodium-glucose cotransporter-2 inhibitors; Glucagon-like peptide-1 receptor agonists

Core Tip: In this study, a cohort of 5482 patients with type 2 diabetes were enrolled and followed up for at least 6 months. After propensity score matching, patients who received glucagon like peptide-1 receptor agonists (GLP-1RAs) or sodium-glucose cotransporter-2 inhibitor (SGLT2i) were compared with those who did not receive either treatment. Patients with increased body mass index were predisposed to treatment with GLP-1RAs, and those with higher urinary albumin-creatinine ratio (UACR) were more likely to be treated with SGLT2is. Patients on SGLT2i or GLP-1RAs showed significant weight loss, a decreasing trend in UACR and comparable glucose-lowering effects compared with patients who received glucose-lowering drugs other than SGLT2i or GLP-1RA in real-world settings.