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

M Luiza Caramori1, Enrico Repetto2, Christopher Perkins2

  • 1Department of Endocrinology and Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

Diabetes, Obesity & Metabolism
|March 12, 2026
PubMed

Insights

Cardio-kidney-metabolic therapies, including GLP-1RA and SGLT2i, show promise for managing Type 1 diabetes with chronic kidney disease. These treatments were associated with reduced albuminuria and were found to be safe in a large patient database.

Area of Science:

  • Endocrinology and Metabolism
  • Nephrology
  • Cardiology

Background:

  • Type 1 diabetes (T1D) is frequently complicated by kidney and cardiovascular diseases.
  • Novel cardio-kidney-metabolic (CKM) therapies, such as GLP-1 receptor agonists (GLP-1RA) and SGLT2 inhibitors (SGLT2i), offer potential benefits.
  • Limited data exist on CKM therapy use and efficacy in T1D patients with chronic kidney disease (CKD).

Purpose of the Study:

  • To investigate the utilization, efficacy, and safety of CKM therapies in T1D patients with CKD.
  • To assess the impact of CKM therapies on kidney function, specifically urinary albumin-to-creatinine ratio (UACR).
  • To evaluate the risk of adverse events like hypoglycemia and diabetic ketoacidosis with CKM therapy use.

Main Methods:

  • Analysis of a large US de-identified database (Optum Market Clarity) from 2016-2023.
  • Inclusion of adult T1D patients with CKD who initiated CKM therapy.
  • Propensity score matching to compare CKM therapy users with non-users; assessment of UACR changes, hypoglycemia, and diabetic ketoacidosis rates.

Main Results:

  • CKM therapy was utilized by over 10% of T1D patients with CKD.
  • Patients on CKM therapy achieved a 30% or greater reduction in UACR more quickly than controls (HR 0.76, p=0.0158).
  • No significant increase in hypoglycemia or diabetic ketoacidosis rates was observed in the CKM therapy group.

Conclusions:

  • CKM therapies are frequently used in T1D patients with CKD and are associated with significant UACR reduction.
  • The use of CKM therapies in this population appears safe, with no increased risk of major adverse events.
  • These real-world findings support the need for randomized clinical trials to confirm the benefits of CKM therapies in T1D and CKD.
Abstract

Keywords:
GLP‐1 analogueSGLT2 inhibitordatabase researchdiabetic nephropathyreal‐world evidencetype 1 diabetes

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