Introduction & Objective: Guideline-directed care of people with type 2 diabetes (T2D) and high risk of cardiovascular disease (CVD) is informed by robust outcome trials. Little is known about the impact of T2D drugs in adults with T2D with moderate CVD risk, particularly on key kidney outcomes.

Methods: We used claims data from OptumLabs® Data Warehouse, linked to 100% sample of Medicare claims, for adults ≥21 years with T2D and moderate baseline CVD risk initiated on a GLP-1RA, SGLT2i, DPP4i, or sulfonylurea between 1/1/2014 and 12/31/2021. We used Cox models in a target trial framework to compare incident rates of a kidney composite outcome, including stage 3-5 chronic kidney disease, kidney failure, or initiation of kidney replacement therapy.

Results: We identified 364,714 adults with T2D, moderate CVD risk, and without stage 3 or greater CKD at baseline (mean age 65.5 years, 48.9% female). Compared to DPP4i, sulfonylurea therapy was associated with increased risk (HR:1.04; 95% CI:1.02-1.06), while SGLT2i (HR:0.70; 95% CI:0.67-0.73) and GLP-1RA (HR:0.87; CI:0.83-0.92) use were associated with lower risks for the kidney composite outcome (Figure).

Conclusion: SGLT2i and GLP-1RA are associated with lower risks, and sulfonylureas are associated with higher risk, for incident kidney disease in people with T2D and moderate CVD risk.

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Disclosure

J.J. Neumiller: Advisory Panel; Bayer Inc., Boehringer-Ingelheim, Eli Lilly and Company, Proteomics International. J. Herrin: None. K. Swarna: None. E. Polley: None. R.J. Galindo: Consultant; Abbott. Other Relationship; Dexcom, Inc. Consultant; Bayer Inc. Other Relationship; Novo Nordisk, Eli Lilly and Company. Consultant; Boehringer-Ingelheim, AstraZeneca. G. Umpierrez: Research Support; Abbott, Bayer Inc., Dexcom, Inc., AstraZeneca. Advisory Panel; Dexcom, Inc. Y. Deng: None. M. Mickelson: None. R.G. McCoy: Research Support; American Diabetes Association. Other Relationship; American Diabetes Association. Consultant; Wolters Kluwer Health. Research Support; National Institutes of Health, Patient-Centered Outcomes Research Institute. Consultant; Yale New Haven Health System.

Funding

Patient-Centered Outcomes Research Institute (PCORI) award (PCS-1409-24099)

© 2024 by the American Diabetes Association
2024
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