Newer diabetes drugs can slow the progression of chronic kidney disease

Newer drugs for type 2 diabetes should also be considered for people with chronic kidney disease and type 2 diabetes to protect against heart and kidney disease and their serious complications, according to a new Scientific Statement from the American Heart Association.

Both sodium glucose co-transporter 2 (SGLT2) inhibitors and glucagon like peptide-1 receptor agonists (GLP-1 RAs) could significantly reduce risks associated with CKD and heart disease based on analyses from multiple, large, international, randomised controlled trials.

A Scientific Statement published in Circulation provides detailed, practical guidance for health care professionals to recognise and treat patients who may benefit from SGLT2 inhibitor and GLP-1 RA medications.

The composite results of the trials found that SGLT2 inhibitors and GLP-1 RAs can safely and significantly reduce the risk of cardiovascular events and death, reduce hospitalisation and slow the progression of chronic to end-stage kidney disease including the risks of dialysis, transplantation or death.

Treatment of type 2 diabetes and chronic kidney disease

Chair of the statement writing committee Janani Rangaswami, said: “A collaborative treatment approach among primary care doctors and specialists in diabetes, cardiology and kidney disease that, when indicated, includes treatment with these two classes of medications could add more heart- and kidney disease-free years and greatly extend survival for people with type 2 diabetes.”

Recommendation from the AHA include:

• Early and ongoing assessment of risks for kidney and heart disease can help identify patients who may benefit from the protective and preventive effects of these medicines.
• Tailor medication choices to meet the needs of each individual patient.
• Monitoring and control of high blood pressure.
• Identify risks for hypoglycemia (low-blood sugar) and educate patients on the signs so they can seek treatment quickly.
• Adjust all medications in tandem with these medicines and consider the burden of “polypharmacy” – meaning taking 5 or more medications daily for multiple conditions, which is common among people with Type 2 diabetes.
• Patients should be counseled about the risks and symptoms of “euglycemic” diabetic ketoacidosis (DKA), when taking SGLT2 inhibitors as well as “classic” DKA (when blood sugar is very high and acidic substances called ketones build up in the body), which is serious and can be fatal.
• The health care professional team should regularly screen and counsel patients about regular foot care to prevent foot ulcers or blisters that can quickly become infected and lead to amputation.

The writing group identified two additional patient subgroups who may benefit from SGLT2 inhibitors and GLP-1 RAs: people with heart failure with reduced ejection fraction (HFrEF) with or without type 2 diabetes; and people with chronic kidney disease who do not have type 2 diabetes. The writing group anticipates more data emerging to validate the use of SGLT2 inhibitors and GLP-1 RA medications for these at-risk patients.

Recent studies show these newer medications are not widely prescribed, especially among patients with higher risks for cardiovascular disease and chronic kidney disease.