Use of sodium glucose cotransporter 2 (SGLT2) inhibitors to treat type 2 diabetes may help to lower the risk of serious kidney problems, according to a Scandinavian study led by researchers at Karolinska Institutet. The findings, now published in the journal The BMJ, provide support for the use of SGLT2 inhibitors in a broad range of patients with type 2 diabetes, according to the researchers.
Type 2 diabetes is the leading cause of kidney failure. Clinical trials have shown that SGLT2 inhibitors protect kidney function among high-risk patients with type 2 diabetes, but their effect on serious renal events in a broader patient population remains uncertain.
In this study, an international team of researchers set out to assess the association between use of SGLT2 inhibitors and risk of serious renal events using data from routine clinical practice. They used nationwide register data from Sweden, Denmark, and Norway from 2013-18 to compare use of SGLT2 inhibitors with another group of diabetes drugs called dipeptidyl peptidase-4 (DPP-4) inhibitors.
Prescription data was used to identify 29,887 new users of SGLT2 inhibitors and 29,887 new users of DPP-4 inhibitors (average age 61 years). Hospital records and death statistics were used to track serious renal events for an average follow-up of two years. These included renal replacement therapy, death from renal causes, and hospital admission for renal events.
Significantly lower risk of serious renal events
The researchers found that compared with DPP-4 inhibitors, use of SGLT2 inhibitors was associated with a reduced risk of serious renal events (2.6 events per 1000 person years versus 6.2 events per 1000 person years). This equates to a 58 percent lower relative risk of serious renal events with SGLT2 inhibitors, according to the researchers.
Further analysis found greater risk reduction in patients with underlying cardiovascular disease and chronic kidney disease.
"Our results suggest that the use of SGLT2 inhibitors, compared with DPP-4 inhibitors, is associated with a significantly reduced risk of serious renal events," says Peter Ueda, postdoctoral researcher at the Department of Medicine, Solna, Karolinska Institutet and the study's corresponding author.
As with all medical treatments in individual patients, the potential benefit of the treatment has to be weighed against the potential risk of side-effects, the researchers note.
The study was financed by the Strategic Research Area Epidemiology programme at Karolinska Institutet, Swedish Heart-Lung Foundation, Swedish Society for Medical Research, Swedish Cancer Society, the Nordic Cancer Union, and the Novo Nordisk Foundation.
This article is based on a press release from The BMJ.
Publication
"Use of sodium-glucose co-transporter 2 inhibitors and risk of serious renal events: Scandinavian cohort study," Björn Pasternak, Viktor Wintzell, Mads Melbye, Björn Eliasson, Ann-Marie Svensson, Stefan Franzén, Soffia Gudbjörnsdottir, Kristian Hveem, Christian Jonasson, Henrik Svanström, Peter Ueda, The BMJ, online April 30, 2020, doi: 10.1136/bmj.m1186
