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Abstract：
BACKGROUND: Renal outcomes in patients with type 2 diabetes following treatment with sodium-glucose co-transporter-2 inhibitors (SGLT2is) or glucagon-like peptide-1 receptor agonists (GLP1RAs) have not been directly compared. This study compared the impact of SGLT2i and GLP1RA therapy on renal function and metabolic parameters.
METHODS: Patients with type 2 diabetes who initiated SGLT2i or GLP1RA therapy in a tertiary hospital between January 2009 and August 2023 were included to assess composite renal outcomes, such as a 40% decline in estimated glomerular filtration rate (eGFR), onset of end-stage renal disease, renal death, or new-onset macroalbuminuria. Alterations in blood pressure, glucose regulation parameters, lipid profile, and anthropometric parameters, including body fat and muscle masses, were examined over 4-years.
RESULTS: A total of 2,112 patients were enrolled using a one-to-three propensity-score matching approach (528 patients for GLP1RAs, 1,584 patients for SGLT2i). SGLT2i treatment was favoured over GLP1RA treatment, though not significantly, for composite renal outcomes (hazard ratio [HR], 0.63; p = 0.097). SGLT2i therapy preserved renal function effectively than GLP1RAs (decrease in eGFR, ≥ 40%; HR, 0.46; p = 0.023), with improving albuminuria regression (HR, 1.72; p = 0.036). SGLT2i therapy decreased blood pressure and body weight to a greater extent. However, more patients attained HbA1c levels < 7.0% with GLP1RAs than with SGLT2is (40.6% vs 31.4%; p < 0.001). GLP1RA therapy enhanced β-cell function and decreased LDL-cholesterol levels below baseline values.
CONCLUSIONS: SGLT2is were superior for preserving renal function and reducing body weight, whereas GLP1RAs were better for managing glucose dysregulation and dyslipidaemia.
METHODS: Patients with type 2 diabetes who initiated SGLT2i or GLP1RA therapy in a tertiary hospital between January 2009 and August 2023 were included to assess composite renal outcomes, such as a 40% decline in estimated glomerular filtration rate (eGFR), onset of end-stage renal disease, renal death, or new-onset macroalbuminuria. Alterations in blood pressure, glucose regulation parameters, lipid profile, and anthropometric parameters, including body fat and muscle masses, were examined over 4-years.
RESULTS: A total of 2,112 patients were enrolled using a one-to-three propensity-score matching approach (528 patients for GLP1RAs, 1,584 patients for SGLT2i). SGLT2i treatment was favoured over GLP1RA treatment, though not significantly, for composite renal outcomes (hazard ratio [HR], 0.63; p = 0.097). SGLT2i therapy preserved renal function effectively than GLP1RAs (decrease in eGFR, ≥ 40%; HR, 0.46; p = 0.023), with improving albuminuria regression (HR, 1.72; p = 0.036). SGLT2i therapy decreased blood pressure and body weight to a greater extent. However, more patients attained HbA1c levels < 7.0% with GLP1RAs than with SGLT2is (40.6% vs 31.4%; p < 0.001). GLP1RA therapy enhanced β-cell function and decreased LDL-cholesterol levels below baseline values.
CONCLUSIONS: SGLT2is were superior for preserving renal function and reducing body weight, whereas GLP1RAs were better for managing glucose dysregulation and dyslipidaemia.
摘要：
背景：2型糖尿病患者接受钠-葡萄糖共转运蛋白-2抑制剂（SGLT2is）或胰高血糖素样肽-1受体激动剂（GLP1RA）治疗后的肾脏结局尚未直接比较。这项研究比较了SGLT2i和GLP1RA治疗对肾功能和代谢参数的影响。
方法：纳入2009年1月至2023年8月在三级医院开始SGLT2i或GLP1RA治疗的2型糖尿病患者，以评估综合肾脏结局。例如估计的肾小球滤过率(eGFR)下降40%，终末期肾病的发作，肾死亡，或新发的大量白蛋白尿。血压的改变,葡萄糖调节参数，血脂谱,和人体测量参数，包括身体脂肪和肌肉，被检查了4年。
结果：使用1-3倾向评分匹配方法共纳入2,112名患者（GLP1RAs的528名患者，1,584名SGLT2i患者）。SGLT2i治疗优于GLP1RA治疗，虽然不重要，对于复合肾脏结局(风险比[HR]，0.63；p=0.097)。SGLT2i治疗比GLP1RAs有效地保护了肾功能(eGFR降低，≥40%;HR,0.46；p=0.023)，随着蛋白尿消退的改善(HR，1.72；p=0.036）。SGLT2i疗法较年夜程度降低血压和体重。然而,与SGLT2is组相比,GLP1RAs组HbA1c水平<7.0%的患者更多(40.6%vs31.4%;p<0.001).GLP1RA治疗增强β细胞功能并降低LDL-胆固醇水平低于基线值。
结论：SGLT2is在保护肾功能和减轻体重方面具有优势，而GLP1RAs更好地管理血糖失调和血脂异常。
方法：纳入2009年1月至2023年8月在三级医院开始SGLT2i或GLP1RA治疗的2型糖尿病患者，以评估综合肾脏结局。例如估计的肾小球滤过率(eGFR)下降40%，终末期肾病的发作，肾死亡，或新发的大量白蛋白尿。血压的改变,葡萄糖调节参数，血脂谱,和人体测量参数，包括身体脂肪和肌肉，被检查了4年。
结果：使用1-3倾向评分匹配方法共纳入2,112名患者（GLP1RAs的528名患者，1,584名SGLT2i患者）。SGLT2i治疗优于GLP1RA治疗，虽然不重要，对于复合肾脏结局(风险比[HR]，0.63；p=0.097)。SGLT2i治疗比GLP1RAs有效地保护了肾功能(eGFR降低，≥40%;HR,0.46；p=0.023)，随着蛋白尿消退的改善(HR，1.72；p=0.036）。SGLT2i疗法较年夜程度降低血压和体重。然而,与SGLT2is组相比,GLP1RAs组HbA1c水平<7.0%的患者更多(40.6%vs31.4%;p<0.001).GLP1RA治疗增强β细胞功能并降低LDL-胆固醇水平低于基线值。
结论：SGLT2is在保护肾功能和减轻体重方面具有优势，而GLP1RAs更好地管理血糖失调和血脂异常。
