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Renal outcomes associated with glucose-lowering agents: Systematic review and meta-analysis of randomized outcome

Konstantina Chalmoukou1, Dimitris Polyzos1, Eleni Manta1

  • 1First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.

European Journal of Internal Medicine
|December 26, 2021
PubMed

Insights

Glucose-lowering medications, specifically GLP-1 agonists and SGLT2 inhibitors, significantly reduce kidney damage progression and macroalbuminuria in patients with type 2 diabetes. DPP-4 inhibitors did not show similar renal protective effects.

Area of Science:

  • Nephrology
  • Endocrinology
  • Clinical Trials

Background:

  • Clinical trials for glucose-lowering drugs primarily focus on macrovascular events.
  • There is a lack of updated reviews on the prevention of renal outcomes in diabetes management.
  • Kidney damage progression and albuminuria are significant complications of diabetes.

Purpose of the Study:

  • To assess the impact of different antihyperglycemic medication classes on kidney damage progression.
  • To provide an updated review of renal outcome prevention in the context of glucose-lowering therapies.
  • To investigate the association between glycemic control and renal outcomes.

Main Methods:

  • Systematic review and meta-analysis of glucose-lowering trials up to June 2021.
  • Inclusion of trials involving patients with type 2 diabetes mellitus versus placebo or less intensive treatment.
  • Extraction of data on kidney function worsening and macroalbuminuria development, with calculation of risk ratios and confidence intervals.

Main Results:

  • A 0.6% reduction in HbA1c was associated with a 17% decrease in kidney function worsening and a 25% decrease in macroalbuminuria.
  • Analogues of human glucagon-like peptide 1 (GLP-1) agonists and sodium-glucose cotransporter (SGLT2) inhibitors significantly reduced both renal outcomes compared to placebo.
  • Dipeptidyl peptidase 4 (DPP-4) inhibitors did not demonstrate a significant impact on renal outcomes.

Conclusions:

  • Glucose-lowering therapies, particularly GLP-1 agonists and SGLT2 inhibitors, offer significant protection against kidney function decline and macroalbuminuria.
  • The reduction in macroalbuminuria is linked to HbA1c reduction, while kidney function decline is associated with systolic blood pressure reduction.
  • DPP-4 inhibitors do not appear to provide renal protection in patients with type 2 diabetes.
Keywords:
CreatinineGlomerular filtration rateGlucose-loweringKidney damageMacroalbuminuriaRenal outcomes

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