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Comparative effects of sodium–glucose cotransporter 2 inhibitors versus dipeptidyl peptidase-4 inhibitors on kidney function decline in Japanese individuals with type 2 diabetes

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Abstract

Background

Limited direct comparative studies exist in terms of the effects of sodium-glucose cotransporter 2 inhibitors (SGLT2is) and dipeptidyl peptidase-4 inhibitors (DPP4is) on the kidney outcomes in Japanese individuals with type 2 diabetes.

Methods

This retrospective cohort study included 561 Japanese adults with type 2 diabetes, who were newly prescribed either an SGLT2i or a DPP4i and had an eGFR ≥ 30 mL/min/1.73 m2. The cohort comprised 207 women and 354 men, with a mean (± standard deviation) age of 63 (± 12) years. The exposure and outcome were SGLT2i or DPP4i initiation and eGFR slope during the overall follow-up period, restricted to participants who were followed for ≥2 years. We adopted the on-treatment analysis. Analysis of covariance was used to compare the adjusted eGFR slope between the two groups, incorporating 10 variables at baseline.

Results

During the median follow-up period of 3.4 years, least square mean (95% CI) eGFR slopes were −1.91 (−2.15, −1.67) and −1.12 (−1.58, −0.67) mL/min/1.73 m2/year in individuals treated with a DPP4i (n = 460) and an SGLT2i (n = 101), respectively, demonstrating statistical significance (p = 0.002). The robustness of this finding was strengthened by sensitivity analyses.

Conclusions

This study provides potential evidence of the superiority of SGLT2is over DPP4is in slowing kidney function decline in Japanese adults with type 2 diabetes and eGFR ≥ 30 mL/min/1.73 m2.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank Honyaku Center Inc. for English language editing.

Funding

We have not received any funding for the present study.

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Authors and Affiliations

  1. Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan

    Naoshi Yoshida, Ko Hanai & Tetsuya Babazono

Authors
  1. Naoshi Yoshida
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  2. Ko Hanai
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  3. Tetsuya Babazono
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Contributions

All authors contributed to the conception and design of the study. NY and KH contributed to the data collection and preparation. KH contributed to the analysis and interpretation of data. NY and KH were responsible for drafting the manuscript. All authors revised the manuscript. All authors have approved the final version of the manuscript. TB is the guarantor of this work, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Ko Hanai.

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Conflicts of interest

The authors have nothing to disclose.

Ethical approval

All procedures performed in the present study were in accordance with the ethical standards of the institutional research committee of Tokyo Women’s Medical University School of Medicine (approval no. 3932) and with the tenets of the Declaration of Helsinki of 1964 and its later versions.

Informed consent

As the present study was an observational and historical but not a prospective interventional study, the ethics committee waived the need for direct informed consent. Instead, we offered participants the opportunity to opt-out to participate.

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Yoshida, N., Hanai, K. & Babazono, T. Comparative effects of sodium–glucose cotransporter 2 inhibitors versus dipeptidyl peptidase-4 inhibitors on kidney function decline in Japanese individuals with type 2 diabetes. Clin Exp Nephrol (2024). https://doi.org/10.1007/s10157-024-02499-2

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