A large US study indicates that GLP-1 receptor agonists and SGLT-2 inhibitors may reduce the risk of kidney deterioration in people with type 2 diabetes and high urinary protein levels, highlighting benefits beyond blood sugar control.
GLP-1 receptor agonists and SGLT-2 inhibitors may help slow kidney decline in people with type 2 diabetes and albuminuria, according to a large US analysis published in The BMJ. The findings add weight to evidence that the two drug classes offer benefits beyond blood sugar control, particularly in patients whose urine contains high levels of protein, a sign of kidney damage.
The study examined health records and insurance claims for 75,455 people with type 2 diabetes who began treatment after metformin between 2014 and 2022. Most participants, 61,583, did not have albuminuria. Researchers followed them for an average of 32 months and used standard blood tests to assess how quickly kidney function declined.
Among people with albuminuria, the estimated five-year risk of kidney deterioration was 3.2% for those taking GLP-1 receptor agonists or SGLT-2 inhibitors, compared with 4.6% for sulfonylureas and 5.4% for DPP-4 inhibitors. In people without albuminuria, the five-year risk was 2.4% for GLP-1 receptor agonists or SGLT-2 inhibitors, 2.8% for sulfonylureas and 2.1% for DPP-4 inhibitors. The authors said the results suggest a clear benefit in the albuminuria group, while sulfonylureas were linked to a higher risk of renal decline in patients without albuminuria.
The BMJ authors also stressed that the work was observational and cannot prove cause and effect. They noted that target trial emulation is among the strongest methods for studying non-randomised data, but it still leaves room for bias and unmeasured confounding. Earlier research has generally pointed in the same direction: studies and reviews published over recent years have found both drug classes can slow eGFR decline, reduce albuminuria and improve cardiorenal outcomes, although some real-world analyses have suggested SGLT-2 inhibitors may provide stronger kidney protection than GLP-1 drugs in certain populations.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
