[Glucagon-like peptide 1 agonists : the fourth pillar of nephroprotection in type 2 diabetes].

GLP1 agonists are the emerging fourth pillar of nephroprotection in type 2 diabetes (T2D), alongside renin-angiotensin system blockers, sodium-glucose cotransporter 2 inhibitors, and finerenone (a non-steroidal mineralocorticoid receptor antagonist). The FLOW study showed that semaglutide 1 mg weekly prescribed in T2D patients with moderate to severe renal disease resulted in a 24 % reduction in the risk of a major renal event (NNT: 20) after a median follow-up of 3.4 years and a 20 % reduction in the relative risk of all-cause mortality (NNT: 39). Tirzepatide (a dual GLP1-GIP agonist) shows promising potential, but further data are awaited. However, their use requires caution, especially with regard to gastrointestinal adverse effects and the risk of muscle loss. A multidisciplinary approach remains essential to optimize their efficacy and safety.