Early biomarkers of diabetic kidney disease. A focus on albuminuria and a new combination of antidiabetic agents.
Por:
Carretero Gómez J, Ena J, Segui J, Carrasco-Sanchez FJ, Gómez Huelgas R, Mateos Polo L, Varela Aguilar JM, Suárez Tembra JM and Arévalo-Lorido JC
Publicada:
1 oct 2020
Ahead of Print:
14 jul 2020
Categoría:
Medicine (miscellaneous)
Resumen:
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.
Filiaciones:
Carretero Gómez J:
Internal Medicine Department, Zafra Hospital, Zafra, Badajoz, Spain
:
Internal Medicine Department, Marina Baixa Hospital, La Vila Joiosa, Alicante, Spain
Segui J:
Internal Medicine Department, San Juan de Alicante University Hospital, San Juan, Alicante, Spain
Carrasco-Sanchez FJ:
Internal Medicine Department, Juan Ramón Jimenez University Hospital, Huelva, Spain
Gómez Huelgas R:
Internal Medicine Department, Regional University Hospital of Málaga, Málaga, Spain
Institute of Biomedical Research in Malaga (IBIMA), CIBER Physiopathology of Obesity and Nutrition - CIBERobn, Málaga, Spain
Mateos Polo L:
Internal Medicine Department, University Hospital of Salamanca, Salamanca, Spain
Varela Aguilar JM:
Internal Medicine Department, Biomedical Research Centre Network for Epidemiology and Public Health (CIBERSAM), Virgen del Rocío University Hospital, Seville, Spain
Suárez Tembra JM:
Lipids and cardiovascular Units, Internal Medicine Department, San Rafael University Hospital, La Coruña, Spain
Arévalo-Lorido JC:
Internal Medicine Department, Zafra Hospital, Zafra, Badajoz, Spain
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