New diabetes drugs effective way to tackle kidney disease
Almost 7000 Australians could be saved from end-stage kidney disease over the next 20 years if we focussed on widespread delivery of newer diabetes medications to address this costly complication, according to Baker Heart and Diabetes Institute research.
The study, published today in the journal Diabetes Care, modelled the impacts of different interventions on the future incidence of end-stage kidney disease, one of the most expensive and burdensome complications of diabetes.
People with type 2 diabetes are 10-times more likely to develop end-stage kidney disease than those without diabetes, and the number of people with diabetes developing the disease each year is predicted to increase by 58 per cent in Australia by 2040.
The study showed that widespread use of a newer class of diabetes medications, called SGLT2 inhibitors, would result in a far larger reduction in the number of people developing end-stage kidney disease by 2040 than would diabetes prevention measures like a tax on sugary drinks or a large-scale lifestyle modification program for people at-risk of diabetes.
Lead author and PhD student, Jedidiah Morton says the research illustrates the need to move diabetes treatment away from a focus only on controlling blood sugar to addressing the damaging complications diabetes can cause to the heart and kidneys as well.
"This new class of drugs — SGLT2 inhibitors — has been shown to have a whole host of benefits that don't appear to be related to blood sugar levels, including some exceptional benefits for kidney and cardiovascular disease," Mr Morton says.
"Right now there are a large number of people with diabetes who could benefit from these medications but are missing out, because SGLT2 inhibitors are still primarily treated as blood sugar lowering drugs by regulators."
Currently, these drugs are only subsidised for patients who meet specific blood sugar levels and kidney function measures.
"But this is a very 'glucose-centric' view of the drugs and means that their other recorded benefits – including for the improvement of kidney health – are not as easily available to a large number of people with diabetes," Mr Morton says.
"What we show in our study is if you allow people with impaired kidney function to start these drugs, we will see a much quicker reduction in end-stage kidney disease at a population level.
"What's more, these people with diabetes who have lower kidney function are at the highest risk of developing end-stage kidney disease and ending up on dialysis, so it's even more crucial they have access to these drugs."
The Baker Institute research follows a report from the George Institute for Global Health, which shows for every $1 invested in making SGLT2 inhibitors more widely available in the Australian community, almost $5 in benefits could be returned to society from a reduction in kidney and heart disease.
Head of the Baker Institute's Diabetes Complications Program and endocrinologist, Professor Jonathan Shaw says it's critical for all people with type 2 diabetes to know that there are medications that can reduce their chances of developing serious kidney disease.
"The other key aspect will be putting pressure on regulatory bodies to change the way they reimburse diabetes drugs, because at the moment Australia is behind the eight ball," Professor Shaw says.
He also noted that while diabetes prevention measures were not as effective as SGLT2 inhibitors in preventing kidney failure in the next 20 years, preventing or delaying diabetes would certainly have important long-term benefits for kidney health, as well as for a range of other health outcomes.
