Taiwan: The use of sodium-glucose cotransporter-2 inhibitors (SGLT2Is) significantly lowers the risk of chronic kidney disease (CKD) in type 2 diabetes patients with a higher DCSI (diabetes complications severity index), reveals a recent study published in the Journal of Nephrology.
Wei-Syun Hu from China Medical University in Taichung, Taiwan, and colleagues aimed to investigate the risk of CKD in type 2 diabetes patients with different scores of adapted DCSI who received SGLT2 inhibitors in a retrospective analysis. The DCSI quantifies the severity and presence of complications based on seven body systems or dimensions. It converts laboratory results and diagnostic codes into a 14-level metric quantifying the long-term diabetes effects on seven body systems.

The analysis included 113,449 patients with type 2 diabetes mellitus (T2DM) from the Taiwan NHIRD (National Health Insurance Research Database). They analyzed data collected from 107,440 patients demonstrating a change in DCSI score of < 1 per year, 2289 patients with a score change of > 2 per year, and 3720 patients with a change in score of 1 to 2 per year.
CKD risk throughout the follow-up period was assessed using Cox proportional hazard models. They were adjusted for age, sex, comorbidities, and medications of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, glucosidase inhibitors, dipeptidyl peptidase-4 inhibitors, biguanides, meglitinides, glucagon-like peptide-1 receptor agonists, insulin, a thiazolidinedione, and sulphonylurea.
The authors reported the following findings:
The incidence of chronic kidney disease rose from 18.30 per 1000 person-years in patients with a score change of < 1 per year to 137.55 per 1000 person-years in patients with a score change of > 2 per year.
Higher score change (> 2 per year) patients who received SGLT2 inhibitors had a lower risk of CKD development than patients who did not receive SGLT2Is.
"The use of sodium-glucose cotransporter-2 inhibitors is significantly linked with the decrease in the incidence of chronic kidney disease in T2DM with a higher diabetes complications severity index," the authors conclude.
About SGLT2 inhibitors
SGLT2 inhibitors are a class of prescription medication approved by the US FDA for use with exercise and diet to lower blood sugar in adults with type 2 diabetes. Medicines in the SGLT2 inhibitor class include dapagliflozin, canagliflozin, and empagliflozin. Their safety and efficacy have not been established in type 1 diabetes patients and are not approved by the FDA for use in these patients.
Reference:
Chen, TS., Yu, TS., Lin, CL. et al. Role of sodium-glucose cotransporter-2 inhibitors in risk of chronic kidney disease among patients with type 2 diabetes mellitus. J Nephrol (2022). https://doi.org/10.1007/s40620-022-01522-7