Combination therapy with SGLT2-Is and MRAs is associated with lower albuminuria in patients with type 2 DM compared to monotherapy with SGLT2-Is or MRAs alone suggests a new study published in Diabetes, Obesity and Metabolism
Diabetes mellitus (DM) is the leading cause of chronic kidney disease. Albuminuria is associated with an increased risk of cardiovascular mortality. Sodium-glucose cotransporter 2 inhibitors (SGLT2-Is) and mineralocorticoid receptor antagonists (MRAs) protect against albuminuria; however, their combined effects on albuminuria are unclear. We performed a network meta-analysis to investigate the effects of SGLT2-Is, MRAs, and their combination on albuminuria in type 2 DM.

They systematically searched PubMed, Medline, EMBASE, and the Cochrane Library from inception up to November 20, 2022. We selected randomized control and crossover trials that compared MRAs, SGLT2-Is, MRAs + SGLT2-Is, or a placebo in patients with type 2 DM with a urinary albumin-creatinine ratio (UACR) ≥ 30 mg/g creatinine. The primary outcome was the change in the UACR.
Results
• This meta-analysis analyzed 17 studies with 34,412 patients.
• The use of combination treatment with SGLT2-Is and MRAs was associated with lower albuminuria compared to the use of SGLT2-Is, MRAs, or the placebo alone
• Treatment with SGLT2-Is or MRAs alone caused a significant reduction in UACR compared to the placebo
• The effects of MRAs on the UACR are comparable to those of SGLT2-Is. Sensitivity analyses showed similar results.
Combination therapy with SGLT2-Is and MRAs was associated with lower albuminuria in patients with type 2 DM compared to monotherapy with SGLT2-Is or MRAs alone.
Reference:
Morita, R., Tsukamoto, S., Obata, S., Yamada, T., Uneda, K., Uehara, T., Rehman, M.E., Azushima, K., Wakui, H. and Tamura, K. (2023), Effects of sodium-glucose cotransporter 2 inhibitors, mineralocorticoid receptor antagonists, and their combination on albuminuria in diabetic patients. Diabetes Obes Metab. Accepted Author Manuscript. https://doi.org/10.1111/dom.14976
Keywords:
Diabetes, Obesity and Metabolism, Morita, R., Tsukamoto, S., Obata, S., Yamada, T., Uneda, K., Uehara, T., Rehman, M.E., Azushima, K., Wakui, H. and Tamura, K, Effects, sodium-glucose, cotransporter 2 inhibitors, mineralocorticoid, receptor antagonists, combination, albuminuria, diabetic patients.