A large US study indicates that newer classes of diabetes medications, GLP-1 receptor agonists and SGLT-2 inhibitors, may significantly slow kidney function decline in people with type 2 diabetes and albuminuria, offering new hope for renal protection.
A large US study published by The BMJ suggests that two newer classes of diabetes drugs may help protect kidney function in people with type 2 diabetes and albuminuria, a marker of kidney damage. The research found that glucagon-like peptide-1, or GLP-1, receptor agonists and sodium glucose cotransporter-2, or SGLT-2, inhibitors were linked with a slower decline in kidney function than some older treatment options.
The findings add weight to earlier research pointing to kidney benefits from both drug classes. Studies published in the Journal of the American College of Cardiology in 2024 also reported protective effects on kidney outcomes for SGLT-2 inhibitors and GLP-1 receptor agonists, while noting that direct comparisons are still needed to determine which approach works best in different patients. Another 2024 analysis in Frontiers in Pharmacology suggested that the order in which the drugs are started may matter when they are used together.
In the BMJ study, researchers analysed health records and insurance claims from 75,455 people with type 2 diabetes who began treatment after metformin between 2014 and 2022. The average age was 60 and 48% were women. Most participants, 82%, did not have albuminuria. Over an average follow-up of 32 months, the team assessed kidney decline using standard blood tests.
Among people with albuminuria, the estimated five-year risk of kidney decline was 3.2% for those treated with GLP-1 receptor agonists or SGLT-2 inhibitors, compared with 4.6% for sulfonylureas and 5.4% for DPP-4 inhibitors. Among those 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 patients with albuminuria, but little evidence of kidney protection in those without it over the study period.
The researchers also cautioned that their work was observational and based on target trial emulation, a method designed to reduce bias but not eliminate it. They noted limits including the relatively short follow-up and the possibility that unmeasured factors affected the results. Even so, they concluded that albuminuria should be taken into account when deciding on treatment, because the kidney benefits seen with GLP-1 receptor agonists and SGLT-2 inhibitors were not uniform across patient groups.
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