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Decision Algorithm for Prescribing SGLT2 Inhibitors and GLP-1 Receptor Agonists for Diabetic Kidney Disease

Jiahua Li1,2,3, Oltjon Albajrami2,4, Min Zhuo1,3,5,6

  • 1Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

Clinical Journal of the American Society of Nephrology : CJASN
|June 11, 2020
PubMed

Insights

Sodium glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) offer vital heart and kidney protection for diabetic patients. This review aids clinicians in optimizing their use for high-risk individuals.

Area of Science:

  • Endocrinology
  • Nephrology
  • Cardiology

Background:

  • Diabetic kidney disease (DKD) and comorbid conditions like atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF) significantly increase risks of kidney failure and cardiovascular mortality.
  • Novel diabetes medications, Sodium-Glucose Cotransporter 2 inhibitors (SGLT2i) and Glucagon-Like Peptide 1 Receptor Agonists (GLP-1 RA), demonstrate potent cardiovascular and kidney protective benefits.
  • Despite evidence, the clinical adoption of SGLT2i and GLP-1 RA for high-risk diabetes patients remains suboptimal.

Purpose of the Study:

  • To provide a clinical decision-making tool for integrating SGLT2i and GLP-1 RA in patients with DKD and high cardiovascular/kidney risk.
  • To compare the efficacy of SGLT2i and GLP-1 RA across different patient risk categories.
  • To present an evidence-based algorithm for prescribing these agents for cardiorenal protection.

Main Methods:

  • Comprehensive risk assessment framework for patients with DKD.
  • Comparative analysis of SGLT2i and GLP-1 RA effectiveness based on cardiovascular and kidney risk stratification.
  • Development of a decision algorithm integrating risk stratification and current evidence strength.
  • Review of adverse effects and mitigation strategies for SGLT2i and GLP-1 RA.

Main Results:

  • SGLT2i and GLP-1 RA have shifted the diabetes treatment paradigm towards cardiorenal protection beyond glycemic control.
  • Clinical guidelines now recommend these agents for comprehensive diabetes management in high-risk populations.
  • A structured approach to risk assessment and evidence evaluation is crucial for optimal prescribing.

Conclusions:

  • SGLT2i and GLP-1 RA are essential for managing patients with DKD and comorbid ASCVD/HF, reducing adverse outcomes.
  • A clear decision-making framework can accelerate the uptake of these life-saving therapies.
  • Clinicians should consider a holistic approach, balancing benefits, risks, and evidence for SGLT2i and GLP-1 RA use.
Keywords:
AlgorithmsBlood GlucoseCardiovascular DiseasesDecision MakingDiabetic NephropathiesGlucagon-Like Peptide 1Glucagon-Like Peptide-1 ReceptorHealth Care CostsRenal InsufficiencyRisk AssessmentSymporterschronic kidney diseasediabetic kidney diseaseglucagon-like peptide-1 receptor agonistheart failurekidneyobesityprescribing algorithmsodium-glucose cotransporter 2 inhibitor

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