Johannes CB, Coleman CI, Kovesdy CP, Khan AM, Ziemiecki R, Layton JB, Vizcaya D, Liu F, Oberprieler NG. Temporal changes in SGLT2 Inhibitor and GLP-1 receptor agonist use in patients with chronic kidney disease and type 2 diabetes, 2012-2023: a US cohort study. Diabetes Ther. 2025 Dec 9. doi: 10.1007/s13300-025-01825-5

INTRODUCTION: Type 2 diabetes is a leading cause of chronic kidney disease (CKD). Individuals with both conditions have increased risk of poor cardiorenal outcomes and mortality. The rapidly evolving landscape for CKD-protective therapies in type 2 diabetes currently includes sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA), both of which demonstrate cardiorenal outcome benefits. As part of the FOUNTAIN platform (ClinicalTrials.gov ID: NCT05526157; EUPAS ID: EUPAS48148), this study aimed to better understand changes in patient characteristics and treatment patterns corresponding with updates to clinical guideline recommendations and drug labeling and the emergence of new CKD-protective therapies such as finerenone in the US in 2021–2022.

METHODS: An observational real-world data study assessed patient characteristics and drug utilization in separate SGLT2i and GLP-1 RA new-user cohorts of adults with CKD and type 2 diabetes in an earlier (1 January 2012–30 June 2021) and a later (9 July 2021–30 September 2023) period using Optum’s de-identified Clinformatics® Data Mart Database (Optum® CDM).

RESULTS: Compared with the earlier period new users, later period new users in both cohorts were older, had more severe CKD, used less intensive type 2 diabetes medication, and had better metabolic control; SGLT2i new users more frequently had no type 2 diabetes therapy before the index date and greater congestive heart failure prevalence; and GLP-1 RA new users had increased SGLT2i use and decreased insulin use.

CONCLUSIONS: These findings inform and contextualize future studies assessing cardiorenal outcomes for these and additional treatments, including finerenone, for individuals with CKD and type 2 diabetes.