Urine protein test could guide personalised diabetes treatment for kidney protection

A simple urine test detecting protein may help doctors tailor diabetes medications to better protect kidneys, with newer drugs showing benefits mainly in those with early kidney damage, according to recent research.

A urine test that detects protein may help doctors decide which diabetes medicines are most likely to protect the kidneys, according to research led by Mass General Brigham and published in the BMJ. The study suggests that the newer drug classes, GLP-1 receptor agonists and SGLT2 inhibitors, were linked with slower kidney decline in people with type 2 diabetes who already had albuminuria, the medical term for protein in the urine. In patients without that sign of kidney damage, however, the benefit was far less clear.

The findings are based on an analysis of medical records from 75,455 adults with type 2 diabetes across the United States, including 13,872 who had protein in their urine before treatment. The researchers followed patients for as long as five years and compared outcomes among those prescribed GLP-1 drugs or SGLT2 inhibitors with those taking sulfonylureas or DPP-4 inhibitors, while all were also using metformin and had moderate cardiovascular risk. In people with albuminuria, the newer medicines were associated with better kidney outcomes than DPP-4 inhibitors. By contrast, in those without protein in their urine, sulfonylureas were linked with a higher risk of kidney deterioration than DPP-4 inhibitors.

Mass General Brigham researcher Alexander Turchin said the results support a more individual approach to treatment rather than a uniform strategy for all patients. The study adds nuance to a growing body of evidence showing that GLP-1 receptor agonists and SGLT2 inhibitors can slow kidney disease progression and reduce cardiovascular risk, as outlined in guidance from the Kidney Disease: Improving Global Outcomes group and reviews from the American Academy of Family Physicians. But it also suggests that the people most likely to gain renal protection may be those already showing early kidney injury.

That matters because type 2 diabetes remains a major cause of chronic kidney disease, and preventing kidney failure is a central part of long-term care. National Kidney Foundation guidance notes that SGLT2 inhibitors and GLP-1 receptor agonists have become important options in diabetes and kidney disease management, although treatment choices still depend on a patient’s overall risk profile, kidney function and ability to tolerate different drugs. The BMJ study does not overturn that broader picture, but it does indicate that a simple urine check could help clinicians better match therapy to the patients sitting in front of them.