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Sodium-Glucose Cotransporter 2 Inhibitors in Diabetic Nephropathy: A Systematic Review and Meta-Analysis
Jaisingh Rajput1, Prajakta V Rajput2, Nihar Jena3
1Family Medicine, Montgomery Family Medicine Residency Program, Baptist Health, Montgomery, USA.
Cureus
|May 18, 2026
Summary
Sodium-glucose cotransporter 2 (SGLT2) inhibitors significantly protect kidneys in diabetic nephropathy patients. This meta-analysis confirms their effectiveness across all chronic kidney disease stages and drug classes, supporting their use in treatment guidelines.
Area of Science:
- Nephrology
- Endocrinology
- Pharmacology
Background:
- Diabetic nephropathy is a leading cause of end-stage renal disease, posing significant clinical and economic burdens.
- Despite improved management, progressive renal dysfunction remains a concern for many patients.
- Sodium-glucose cotransporter 2 (SGLT2) inhibitors show renoprotective effects beyond glycemic control.
Purpose of the Study:
- To systematically review and meta-analyze the evidence on the efficacy and safety of SGLT2 inhibitors in diabetic nephropathy.
- To synthesize findings from randomized controlled trials to assess the impact of SGLT2 inhibitors on renal outcomes.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials adhering to PRISMA guidelines.
- Inclusion of twenty studies with a total of 131,011 participants.
Main Results:
- SGLT2 inhibitor therapy significantly reduced composite renal outcomes by 30% (RR 0.70; 95% CI 0.67-0.73).
- Benefits were consistent across all SGLT2 inhibitor classes, all stages of chronic kidney disease (CKD), and with or without background renin-angiotensin system (RAS) inhibitor use.
- Minimal heterogeneity was observed across the included studies (I² = 8.3%).
Conclusions:
- SGLT2 inhibitors provide significant renal protection in patients with diabetic nephropathy.
- Consistent benefits across diverse patient subgroups support their role as foundational organ-protective therapy.
- Findings advocate for the incorporation of SGLT2 inhibitors into clinical practice guidelines for diabetic kidney disease management.
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