Cardio-Kidney-Metabolic Therapy Use Among Adults With Type 1 Diabetes and Chronic Kidney Disease.

AIMS: Kidney and cardiovascular diseases are highly prevalent among patients with Type 1 diabetes. To date, no randomised clinical trial has reported on the impact of novel cardio-kidney-metabolic (CKM) therapies (GLP-1RA and SGLT2i) on kidney function in this population. We investigated a large US database to determine whether CKM therapies were used, beneficial and safe among patients with Type 1 diabetes and chronic kidney disease (CKD).

MATERIALS AND

METHODS

Adults with Type 1 diabetes in Optum's de-identified Market Clarity database, consisting of claims and electronic medical records data, between January 1, 2016, and December 31, 2023, were included. Patients who had their first CKM therapy prescription during the study period were propensity score-matched to those not on CKM therapy. The 253 patients with sufficient data to assess changes in urinary albumin-to-creatinine ratio (UACR) were included in the analyses. Rates of hypoglycaemia and diabetic ketoacidosis were also assessed.

RESULTS

CKM therapy was used by more than 10% of the patients with Type 1 diabetes and CKD. At baseline, average age was 52 years, HbA1c 8.1%, eGFR 77 mL/min/1.73 m2. UACR median was 60.8 mg/g. Time to 30% or more UACR reduction was shorter among patients on CKM therapy versus controls [HR 0.76 (CI 0.61-0.95), p = 0.0158]. Rates of hypoglycaemia and diabetic ketoacidosis were not increased among patients on CKM therapy.

CONCLUSIONS

CKM therapy was frequently used in patients with Type 1 diabetes and CKD, associated with UACR reduction and safe. These clinically relevant data warrant confirmation in randomised clinical trials.