T2DM with CKD: SGLT2 inhibitors reduce CV, renal events

  • Toyama T & al.
  • Diabetes Obes Metab
  • 29 Jan 2019

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • Sodium glucose co-transporter 2 (SGLT2) inhibitors slightly reduce HbA1c but significantly reduce the risk for cardiovascular (CV) and renal events in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD).

Why this matters

  • Data on SGLT2 inhibitors in CKD are limited, due to their renal-based mechanism of action.

Study design

  • Meta-analysis of 27 studies with randomized controlled data (n=7363); 8 were pooled analyses (41 trials).
  • Funding: National Health and Medical Research Council of Australia.

Key results

  • In comorbid T2DM+CKD, SGLT2 inhibitors reduced HbA1c (–0.29%; 95% CI, –0.39% to –0.19%).
    • Fasting glucose, blood pressure, body weight, and albuminuria also reduced.
  • SGLT2 inhibitors reduced the risk for the composite endpoint of CV death, nonfatal myocardial infarction, or nonfatal stroke (relative risk [RR]=0.81; 95% CI, 0.70-0.94) and heart failure (RR=0.61; 95% CI, 0.48-0.78).
    • No significant effect on all-cause mortality (RR=0.86; 95% CI, 0.73-1.01).
  • SGLT2 inhibitors also:
    • Slowed annual decline in estimated glomerular filtration rate (Δ vs placebo, 1.35; 95% CI, 0.78-1.93 mL/minute/1.73 m2/year).
    • Reduced risk for composite renal outcome of doubled serum creatinine, end-stage renal disease, or renal death (RR=0.71; 95% CI, 0.53-0.95).
  • No new safety signals observed.

Limitations

  • Data mostly derived from subgroup analysis of 3 large trials.
  • Likely underpowered to detect harms.

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