OBJECTIVES: This study aimed to evaluate renal functional preservation (RFP) of SGLT2 inhibitor (SGLT2i) vs DPP4 inhibitor (DPP4i) in Japanese type 2 diabetes (T2D) patients and identify patient sub-groups showing additional RFP benefit with SGLT2i treatment using real world (RW) data.

METHODS: Using claims data 1/4/2008-30/9/2017 from Medical Data Vision (MDV) database, patients were included if they had T2D diagnosis, ≥1 SGLT2i or DPP4i claims between 1/5/2014-30/9/2016 (first claims date as index date), age ≥18 years, ≥1 eGFR during 6-months baseline and 9-15 months in follow-up, continuous treatment until follow-up eGFR, and active in MDV during baseline. Patients in SGLT2i group with first-ever DPP4i claims in follow-up and those in DPP4i group with SGLT2i claims in baseline or follow-up were excluded. Endpoint was percent of patient with RFP defined as no change or positive change in eGFR baseline to follow-up. RFP was compared between groups using logistic regression adjusted for a propensity score based on socio-demographic and clinical covariates. Separately, Q-Finder (proprietary supervised learning algorithm) was implemented to identify profiles of patients who showed additional RFP benefit of SGLT2i vs DPP4i. At profile level, RFP was assessed using logistic regression and HbA1c change using a Gaussian regression, both adjusted for confounding factors.

RESULTS: The study included 5,247 T2D patients (SGLT2i, n=990; DPP4i, n=4,257). SGLT2i patients were younger (58y vs 69y), had longer disease duration (7y vs 5y), higher BMI, higher eGFR, and higher HbA1c at baseline. Significantly higher proportion of patients with RFP favored SGLT2i vs DPP4i group (OR=1.27, p=0.01). The study also identified 4 clinical-relevant sub-groups exhibiting superiority of the SGLT2i effect compared to DPP4i in terms of RFP (p<0.1) with comparable glycaemic control.

CONCLUSIONS: This study showed at different levels a favorable renal functional preservation associated to SGLT2i treatment compared to DPP4i in RW clinical setting in Japan.