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GLP-1 Receptor Agonists and SGLT-2 Inhibitors in Diabetic Nephropathy: A Comparative Study

Sara Ghadeer Alghadeer1, Sama Sami Kanfar1, Zakiah Dheya Algallaf1

  • 1Imam Abdulrahman bin Faisal, King Fahad University Hospital, Dammam, Kingdom of Saudi Arabia.

Saudi Medical Journal
|July 14, 2026
PubMed
Abstract

Insights

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose co-transporter-2 inhibitors (SGLT-2i) offer comparable benefits for type 2 diabetes mellitus (T2DM) patients. GLP-1RAs showed better reduction in albuminuria, indicating potential for superior kidney protection.

Area of Science:

  • Nephrology
  • Endocrinology
  • Pharmacology

Background:

  • Type 2 diabetes mellitus (T2DM) is a leading cause of chronic kidney disease.
  • Diabetic nephropathy management requires effective glycemic control and renoprotective strategies.
  • Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose co-transporter-2 inhibitors (SGLT-2i) are novel therapeutic classes for T2DM with potential renal benefits.

Purpose of the Study:

  • To investigate the effects of GLP-1RAs on renal function in T2DM patients.
  • To compare the efficacy of GLP-1RAs versus SGLT-2i in managing diabetic nephropathy.
  • To evaluate the impact of these agents on estimated glomerular filtration rate (eGFR) and albuminuria.

Main Methods:

  • Retrospective cohort study of 115 adult T2DM patients with eGFR ≥60 mL/min/1.73m².
  • Patients were treated with either GLP-1RAs or SGLT-2i for over one year.
  • Exclusion criteria included renal replacement therapy, nephrotoxic drugs, and incomplete records. Data analyzed using Jeffrey's Amazing Statistics Program (p < 0.05).

Main Results:

  • Both GLP-1RAs and SGLT-2i groups showed minimal improvements in glycemic control (HbA1c).
  • eGFR showed minimal improvement with GLP-1RAs (0.5-1.2 mL/min/1.73m²) and variable changes with SGLT-2i (-1.2 to +10.1 mL/min/1.73m²).
  • Urine albumin/creatinine ratio decreased with GLP-1RAs (-13.35 mg/g) but increased with SGLT-2i (+49.86 mg/g).

Conclusions:

  • GLP-1RAs and SGLT-2i provide comparable glycemic and renal benefits in T2DM patients.
  • GLP-1RAs demonstrated a more favorable impact on reducing albuminuria.
  • GLP-1RAs may offer superior renal protection in early-stage diabetic nephropathy.
Keywords:
Chronic kidney diseaseDiabetic nephropathiesGLP-1r agonistsSGLT-2 inhibitors

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