Comparison of renal outcomes between sodium-glucose cotransporter 2 inhibitor and glucagon-like peptide 1 receptor agonist in Japanese patients with type 2 diabetes and obesity.

INTRODUCTION

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1Ra) have shown renoprotective effects in type 2 diabetes (T2D). Our previous findings suggested superior renal outcomes with SGLT2i compared to GLP-1Ra, particularly due to greater reductions in blood pressure (BP). However, whether this benefit extends to obese patients remains unclear. This study compared renal outcomes between SGLT2i and GLP-1Ra in obese Japanese patients with T2D.

METHODS

This retrospective study included patients with T2D and body mass index ≥ 25 kg/m2 treated with either SGLT2i (n = 439) or GLP-1Ra (n = 174) for over one year. Patients receiving both drugs were excluded. The renal composite outcome was defined as an annual decline in estimated glomerular filtration rate (eGFR) > 30%, progression of albuminuria category, or both. Propensity score matching was applied to balance baseline characteristics.

RESULTS

After matching (n = 89 per group), the incidence of renal events did not differ significantly between the two groups. The annual decline in eGFR tended to be smaller with SGLT2i than with GLP-1Ra (- 1.6 ± 3.5 vs. - 2.8 ± 5.8 mL/min/1.73 m2/year, p = 0.13). SGLT2i-treated patients also showed greater reductions in systolic BP and body weight (BW) (- 5.0 ± 19.7 vs. - 1.1 ± 18.0 mmHg, p = 0.19; - 3.3 ± 4.6 vs. - 1.9 ± 4.9 kg, p = 0.05, respectively).

CONCLUSION

Among this population, the annual eGFR decline appeared numerically smaller with SGLT2i-tretament, without statistical significance. Greater BP and BW reductions were observed, though their impact on renal outcomes remains uncertain.