Early biomarkers of diabetic kidney disease. A focus on albuminuria and a new combination of antidiabetic agents. Issue 10 (14th July 2020)

• Record Type: Journal Article
• Authors: Carretero Gómez, Juana; Ena, Javier; Seguí Ripoll, Jose M.; Carrasco‐Sanchez, Francisco J.; Gómez Huelgas, Ricardo; Mateos Polo, Lourdes; Varela Aguilar, José M.; Suárez Tembra, José M.; Arévalo‐Lorido, José C.
• Is Part Of: International journal of clinical practice. Volume 74:Issue 10(2020)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-07-14
• Subjects: Clinical medicine -- Periodicals; Medicine -- Periodicals; 610.5
• DOI: 10.1111/ijcp.13586
• Languages: English
• ISSNs: 1368-5031

Abstract

Abstract: Aims: We aimed to determine the efficacy and safety of sodium‐glucose cotransporter type 2 inhibitors (SGLT2i) and glucagon‐like peptide‐1 receptor agonists to prevent worsening urinary albumin‐to‐creatinine ratio as an early biomarker of diabetes kidney disease. Methods: A total of 178 patients with type 2 diabetes and obesity received combination treatment with SGLT2i added to GLP1ra (n = 76), GLP1ra added to SGLT2i (n = 50) or GLP1ra plus SGLT2i from start (n = 52), according to investigators´ best clinical judgement. Major outcomes assessed at 26 weeks were changes in urine albumintocreatinine‐ratio (UACR), estimated glomerular filtration rate (eGFR), glycated haemoglobin, body weight and systolic blood pressure. Results: All patients (58.6% men, mean age 61.9 ± 10.0 years) completed the study. Baseline HbA1c, weight and eGFR levels were 8.2 ± 0.9%, 109.9 ± 19 kg and 83.3 ± 19.6 mL/min/m 2, respectively. At 26 weeks, we found significant reductions in HbA1c (1.16%), weight (5.17 kg) and systolic blood pressure (8.13 mmHg). The reduction in UACR was 15.14 mg/g (95% CI 8.50‐22.4) (−24.6 ± 64.7%), which was greatest in the group of patients with SGLT2i added on to GLP1ra therapy (116.7 mg/g; 95% CI: 54‐296.5 mg/g; P < .001. Patients with urinary albumin‐to‐creatinine ratio ≥30 mg/g, showed a higher declines (63.18 mg/g [95% CI 44.5‐104.99]) (−56 ± 65.9%). The greatest reduction in urinary albumin‐to‐creatinine ratio was obtained when SGLT2i was added to GLP1ra (116.7 mg/g). The eGFR did not significantly change along the study period. Conclusion: Our results show the beneficial effect of GLP1ra and SGLT2i combination therapy on early biomarkers of diabetes kidney disease such as albuminuria and in other significant outcomes for diabetes control.