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Introduction <p>Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1Ra) have shown renoprotective effects in type 2 diabetes (T2D). Our previous findings suggested superior renal outcomes with SGLT2i compared to GLP-1Ra, particularly due to greater reductions in blood pressure (BP). However, whether this benefit extends to obese patients remains unclear. This study compared renal outcomes between SGLT2i and GLP-1Ra in obese Japanese patients with T2D.</p> Methods <p>This retrospective study included patients with T2D and body mass index ≥ 25&#xa0;kg/m<sup>2</sup> treated with either SGLT2i (n = 439) or GLP-1Ra (n = 174) for over one year. Patients receiving both drugs were excluded. The renal composite outcome was defined as an annual decline in estimated glomerular filtration rate (eGFR) &gt; 30%, progression of albuminuria category, or both. Propensity score matching was applied to balance baseline characteristics.</p> Results <p>After matching (n = 89 per group), the incidence of renal events did not differ significantly between the two groups. The annual decline in eGFR tended to be smaller with SGLT2i than with GLP-1Ra (− 1.6 ± 3.5 vs. − 2.8 ± 5.8&#xa0;mL/min/1.73 m<sup>2</sup>/year, <i>p</i> = 0.13). SGLT2i-treated patients also showed greater reductions in systolic BP and body weight (BW) (− 5.0 ± 19.7 vs. − 1.1 ± 18.0&#xa0;mmHg, <i>p</i> = 0.19; − 3.3 ± 4.6 vs. − 1.9 ± 4.9&#xa0;kg, <i>p</i> = 0.05, respectively).</p> Conclusion <p>Among this population, the annual eGFR decline appeared numerically smaller with SGLT2i-tretament, without statistical significance. Greater BP and BW reductions were observed, though their impact on renal outcomes remains uncertain.</p>

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Comparison of renal outcomes between sodium-glucose cotransporter 2 inhibitor and glucagon-like peptide 1 receptor agonist in Japanese patients with type 2 diabetes and obesity

  • 期刊论文

  • 发表日期：

    2026年3月16日

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  • Yukihiro Wada,
  • Masao Toyoda,
  • Kazuo Kobayashi,
  • Togo Aoyama,
  • Akira Kanamori,
  • Yasuo Takeuchi

摘要

Introduction

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1Ra) have shown renoprotective effects in type 2 diabetes (T2D). Our previous findings suggested superior renal outcomes with SGLT2i compared to GLP-1Ra, particularly due to greater reductions in blood pressure (BP). However, whether this benefit extends to obese patients remains unclear. This study compared renal outcomes between SGLT2i and GLP-1Ra in obese Japanese patients with T2D.

Methods

This retrospective study included patients with T2D and body mass index ≥ 25 kg/m2 treated with either SGLT2i (n = 439) or GLP-1Ra (n = 174) for over one year. Patients receiving both drugs were excluded. The renal composite outcome was defined as an annual decline in estimated glomerular filtration rate (eGFR) > 30%, progression of albuminuria category, or both. Propensity score matching was applied to balance baseline characteristics.

Results

After matching (n = 89 per group), the incidence of renal events did not differ significantly between the two groups. The annual decline in eGFR tended to be smaller with SGLT2i than with GLP-1Ra (− 1.6 ± 3.5 vs. − 2.8 ± 5.8 mL/min/1.73 m2/year, p = 0.13). SGLT2i-treated patients also showed greater reductions in systolic BP and body weight (BW) (− 5.0 ± 19.7 vs. − 1.1 ± 18.0 mmHg, p = 0.19; − 3.3 ± 4.6 vs. − 1.9 ± 4.9 kg, p = 0.05, respectively).

Conclusion

Among this population, the annual eGFR decline appeared numerically smaller with SGLT2i-tretament, without statistical significance. Greater BP and BW reductions were observed, though their impact on renal outcomes remains uncertain.