Concomitant insulin may counter renoprotective effects of SGLT2is in T2D patients with CKD

Renal composite outcomes (RCO) appear to be less favourable among type 2 diabetes (T2D) patients with chronic kidney disease (CKD) treated with insulin and sodium-glucose cotransporter 2 inhibitors (SGLT2i), a recent Japan study has found.

Researchers conducted a retrospective analysis of 624 patients who received SGLT2i treatment; meanwhile, 169 participants also received concomitant insulin. RCO was defined as the progression of albuminuria stage or a ≥15-percent annual reduction in estimated glomerular filtration rate (eGFR).

In the overall unmatched cohort, 71 patients achieved the RCO, yielding a rate of 11.4 percent. After propensity score matching, 149 patients remained in each of the insulin-treated and -untreated cohorts. Those who received concomitant insulin treatment saw a significantly higher incidence rate of RCO than untreated controls (15.4 percent vs 6.7 percent, respectively; p=0.02).

Both components of RCO—albuminuria progression (12.8 percent vs 6.7 percent; p=0.11) and annual eGFR decrease by ≥15 percent (2.7 percent vs 0 percent; p=0.13)—were also more common in insulin-treated patients, though not significantly so.

“The present study showed that, in patients using SGLT2is, for which there is abundant evidence of renoprotective effects, a different effect than previously reported was observed in the group receiving concomitant insulin treatment,” the researcher said.

“The combination of SGLT2is and insulin treatment is widely used in the clinical setting. Therefore, it would be useful to clarify whether or not the combination of insulin treatment and SGLT2is attenuates the renoprotective effect of SGLT2is,” they added.