ASSOCIATION BETWEEN SGLT2 INHIBITOR INITIATION AND ANNUALIZED EGFR CHANGE IN PATIENTS WITH TYPE 2 DIABETES: A JAPANESE REAL-WORLD COHORT STUDY
Author(s)
Keiko S. Maruyama, PhD1, Hisateru Tachimori, PhD1, Shuhei Nomura, PhD2, Ataru Igarashi, PhD3, Yoshiaki Kanamori, MS1, Hiroaki Miyata, PhD1.
1Keio University, Tokyo, Japan, 2Tohoku University, Miyagi, Japan, 3The University of Tokyo, Tokyo, Japan.
1Keio University, Tokyo, Japan, 2Tohoku University, Miyagi, Japan, 3The University of Tokyo, Tokyo, Japan.
OBJECTIVES: To evaluate the association between sodium-glucose cotransporter 2 inhibitor (SGLT2i) initiation and annualized estimated glomerular filtration rate (eGFR) changes among patients with type 2 diabetes mellitus (T2DM) using Japanese municipal real-world data.
METHODS: A retrospective new-user cohort study was conducted using municipal National Health Insurance claims and health checkup data from 2020 to 2023. Patients with T2DM newly initiating either SGLT2 inhibitors (SGLT2 group) or comparator glucose-lowering drugs (metformin and/or dipeptidyl peptidase-4 inhibitors; control group) after a 10-month washout period were identified. Baseline eGFR was defined as the most recent value within 365 days before index, and follow-up eGFR as the latest available value ≥365 days after index. The primary outcome was annualized eGFR change (mL/min/1.73m²/year). Multivariable linear regression adjusted for age, sex, and baseline eGFR.
RESULTS: A total of 1,355 patients were included (control: n=985; SGLT2: n=370). Mean age was 67.0 and 66.0 years, and mean baseline eGFR was 72.8 and 71.3 mL/min/1.73m² in the control and SGLT2 groups, respectively. Mean follow-up duration was approximately 1.7 years in both groups. Annualized eGFR decline was slower in the SGLT2 group than in the control group (−1.00 vs. −2.07 mL/min/1.73m²/year; crude difference, 1.06; 95% confidence interval [CI], 0.22-1.91; p=0.013). After adjustment, SGLT2i initiation remained significantly associated with slower eGFR decline (adjusted difference, 0.80 mL/min/1.73m²/year; 95% CI, 0.06-1.54; p=0.034).
CONCLUSIONS: In routine Japanese clinical practice, SGLT2i initiation was associated with slower annualized eGFR decline compared with other glucose-lowering therapies. Although follow-up duration was relatively short, these findings suggest the feasibility of evaluating kidney function trajectories using municipal real-world data and warrant further investigation with longer follow-up and more comprehensive confounding adjustment.
METHODS: A retrospective new-user cohort study was conducted using municipal National Health Insurance claims and health checkup data from 2020 to 2023. Patients with T2DM newly initiating either SGLT2 inhibitors (SGLT2 group) or comparator glucose-lowering drugs (metformin and/or dipeptidyl peptidase-4 inhibitors; control group) after a 10-month washout period were identified. Baseline eGFR was defined as the most recent value within 365 days before index, and follow-up eGFR as the latest available value ≥365 days after index. The primary outcome was annualized eGFR change (mL/min/1.73m²/year). Multivariable linear regression adjusted for age, sex, and baseline eGFR.
RESULTS: A total of 1,355 patients were included (control: n=985; SGLT2: n=370). Mean age was 67.0 and 66.0 years, and mean baseline eGFR was 72.8 and 71.3 mL/min/1.73m² in the control and SGLT2 groups, respectively. Mean follow-up duration was approximately 1.7 years in both groups. Annualized eGFR decline was slower in the SGLT2 group than in the control group (−1.00 vs. −2.07 mL/min/1.73m²/year; crude difference, 1.06; 95% confidence interval [CI], 0.22-1.91; p=0.013). After adjustment, SGLT2i initiation remained significantly associated with slower eGFR decline (adjusted difference, 0.80 mL/min/1.73m²/year; 95% CI, 0.06-1.54; p=0.034).
CONCLUSIONS: In routine Japanese clinical practice, SGLT2i initiation was associated with slower annualized eGFR decline compared with other glucose-lowering therapies. Although follow-up duration was relatively short, these findings suggest the feasibility of evaluating kidney function trajectories using municipal real-world data and warrant further investigation with longer follow-up and more comprehensive confounding adjustment.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
CO8
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity), SDC: Urinary/Kidney Disorders