Cardiometabolic & kidneyCohort study
Kidney and Cardiovascular Effectiveness of SGLT2 Inhibitors vs GLP-1 Receptor Agonists in Type 2 Diabetes
- Retrospective cohort study
- propensity score overlap weighting
- electronic health record data from 20 US health systems (PCORnet)
Authors' conclusion
SGLT2i and GLP-1 RAs led to similar kidney and cardiovascular outcomes in people with T2D, though SGLT2i initiation was associated with a lower risk of 40% eGFR decline.
Study context
- Population
- Adults with T2D, 20 US health systems (PCORnet), 2015–2020weighted cohort
- Participants
- 35,004 vs 47,268
- Exposure
- SGLT2 inhibitors vs GLP-1 receptor agonists
- SGLT2in = 35,004
- GLP-1 RAn = 47,268reference
- Outcome
- Composite of:
- Sustained 40% estimated glomerular filtration rate (eGFR) decline
- Incident end-stage kidney disease
- All-cause mortality
- Follow-up
- Over 2 years or until censoring
Main finding
As reported in the abstract
median 1.2 years
Hazard ratio
0.91
95% CI 0.81–1.02
SGLT2i vs GLP-1 RA
HR 0.91 (95% CI 0.81–1.02)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| 40% eGFR decline · median 1.2 years | 0.77 (0.65–0.91) | |
| 0.512Hazard ratio (log scale) |
Mortality
- Did not differ, HR
- 1.08 (95% CI 0.92-1.27)
Composite of stroke, MI or death
- Did not differ, HR
- 1.03 (95% CI 0.93-1.14)
HF hospitalization
- Did not differ, HR
- 0.95 (95% CI 0.80-1.13)
Results by CKD status (subgroup)
- Results similar regardless of CKD status
Safety
Genital mycotic infections and other safety outcomes
- Genital mycotic infections more common with SGLT2i; other safety outcomes did not differ
Original publication
Kidney and Cardiovascular Effectiveness of SGLT2 Inhibitors vs GLP-1 Receptor Agonists in Type 2 Diabetes. J Am Coll Cardiol. Published 20 August 2024. doi:10.1016/j.jacc.2024.06.016
Summarised from the published abstract; every number is checked against it