Clinical outcomes in people with type 2 diabetes and acute kidney disease: combined SGLT2i and GLP-1RA therapy vs. monotherapy.
Journal
Diabetes research and clinical practice
Journal Volume
226
Start Page
Article number 112339
ISSN
1872-8227
Date Issued
2025-06-26
Author(s)
Abstract
Aims: To evaluate the effectiveness of combined therapy of Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and Glucagon-like peptide-1 receptor agonists (GLP-1RAs) versus monotherapy in patients with type 2 diabetes mellitus (T2DM) and acute kidney disease (AKD). Methods: This cohort study used TriNetX from adults with T2DM and AKD, treated with either SGLT2i, GLP-1RAs, or both from 2012 to 2023. Outcomes were all-cause mortality, major adverse kidney events (MAKE), and major adverse cardiovascular events (MACE). Results: Among 29,269 patients, 1,591 (5.4 %) received combined therapy, 6,327 in the SGLT2i group, and 5,968 in the GLP-1RAs group. The combined group had significantly lower risks of all-cause mortality compared to SGLT2i monotherapy (aHR = 0.53) and GLP-1RAs monotherapy (aHR = 0.43) after a mean follow-up of 2.4 years. The combined group showed lower risks of MAKE compared to SGLT2i monotherapy (aHR = 0.70) and GLP-1RAs monotherapy (aHR = 0.45) after a mean follow-up of 2.7 years. MACE risk was similar across groups. The combined group had a higher risk of hypoglycemia (aHR = 1.51), diabetic retinopathy (aHR = 1.59) compared to the SGLT2i monotherapy group. Conclusions: Combined SGLT2i and GLP-1RA therapy offers better survival and kidney protection but requires careful monitoring for hypoglycemia and retinopathy.
Subjects
Combination
Glucagon-Like Peptide-1 Receptor Agonists
Mortality
Sodium-glucose cotransporter 2 inhibitors
Type
journal article