Newer treatments for type 2 diabetes have been shown to slow down the progression of chronic kidney disease only in patients with high protein levels in their urine, according to a study out this week.
The authors of the US study said their findings support taking albuminuria measurements into account when deciding on type 2 diabetes treatments for people at risk of developing chronic kidney disease.
“GLP-1 receptor agonists or SGLT-2 inhibitors slowed the decrease in renal function in people with type 2 diabetes with moderately increased albuminuria”
Study authors
Previous studies have suggested that patients with type 2 diabetes who take a glucagon-like peptide-1 (GLP-1) receptor agonist or sodium glucose cotransporter 2 (SGLT-2) inhibitor may have a slower progression of chronic kidney disease than people given other treatments.
The current study, published in the British Medical Journal, looked to see if this renal impact was as strong in people without protein in their urine as it was in those with protein in their urine – albuminuria.
The study included data from more than 75,000 patients with type 2 diabetes who were taking either a GLP-1 receptor agonist, an SGLT-2 inhibitor, a sulfonylurea or a dipeptidyl peptidase-4 (DPP-4) inhibitor.
At the start of the study, all the participants had moderate cardiovascular risk and kidney function that ranged from normal to mildly impaired. Just over 18% of the participants also had albuminuria.
After an average follow-up of 32 months, the researchers saw a protective effect from GLP-1 agonist or SGLT-2 inhibitor treatment on kidney function only in people with albuminuria.
Compared to people given DPP-4 treatment, those with albuminuria given a GLP-1 or SGLT-2 drug were 40% less likely to experience a significant loss of kidney function over five years, the researchers found.
But in the majority who did not have albuminuria, the risk of a significant decline in kidney function over five years was similar in those taking a GLP-1 or SGLP-2 inhibitor and those taking a DPP-4 inhibitor.
However, those without albuminuria who received sulfonylurea treatment were 31% more likely to experience significant loss of kidney function over five years compared to those taking DPP-4 inhibitors.
The researchers said their results underscored the importance of taking into account albuminuria when making treatment decisions for diabetes patients who were at risk of developing chronic kidney disease.
They said: “Compared with DPP-4 inhibitors, GLP-1 receptor agonists or SGLT-2 inhibitors slowed the decrease in renal function in people with type 2 diabetes with moderately increased albuminuria, but not in those without albuminuria.”
They added: “Sulfonylureas led to faster decline in renal function in people with type 2 diabetes and normo-albuminuria.
“These results underscore the importance of considering albuminuria when making treatment decisions for people with type 2 diabetes at risk of declining renal function,” the researchers said.
“Prevention of deterioration of kidney function in people without albuminuria remains a challenge,” noted the study authors from Brigham and Women’s Hospital in Boston.
They added that further research was needed to identify treatments that could prevent the progression of kidney disease in the large population of people with type 2 diabetes without albuminuria.
GLP-1 drugs research timeline