Popular diabetes/weight-loss drugs show additional benefit
Diabetes patients with related chronic kidney disease have better long-term outcomes on GLP1-RA therapies, UTSW researchers find
DALLAS – Feb. 10, 2025 – A well-known class of drugs used to manage Type 2 diabetes and control weight could offer hope for patients who also struggle with related chronic kidney disease (CKD), researchers at UT Southwestern Medical Center found.
The medications, known as glucagon-like peptide-1 receptor agonists (GLP1-RAs), include semaglutides, liraglutides, dulaglutides, and more, available under a variety of brand names. UTSW researchers and their colleagues found that these drugs provide three significant benefits for patients with diabetes-related kidney disease compared with another common class of medications known as dipeptidyl peptidase-4 inhibitors (DPP4is): reducing hospitalization, all-cause mortality, and kidney disease progression.
“The benefits of GLP1-RA therapy for blood glucose management are well known, but our research provides much-needed evidence in support of the renal-protective effect of GLP1-RAs in high-risk patients with moderate to advanced chronic kidney disease,” said first author Shuyao Zhang, M.D., Assistant Professor of Internal Medicine in the Division of Endocrinology at UT Southwestern. Dr. Zhang worked under the mentorship of co-senior authors Ildiko Lingvay, M.D., M.P.H., M.S.C.S., Professor of Internal Medicine in the Division of Endocrinology and in the Peter O’Donnell Jr. School of Public Health, and Ishak A. Mansi, M.D., Professor of Internal Medicine at the University of Central Florida College of Medicine.
The study, published in Nature Communications, was designed to emulate a clinical trial, using data from a nationwide cohort of patients at Veterans Health Administration hospitals and clinics. Researchers analyzed the medical records of 64,705 veterans with diabetes and CKD – divided into propensity-matched pairs of people who initiated GLP1-RA or DPP4i, to ensure there was no significant difference in baseline characteristics between the two groups. Propensity-matched pairs include one individual from a treatment group and one from a control group who have a high probability of receiving the same treatment based on their symptoms.
Over the study period of almost two years, the data showed significant reductions in acute health care utilization (10% lower); death from any cause (16% lower); and kidney disease progression (36% lower) among patients initiated on a GLP1-RA vs. DPP4i.
Patients with CKD and end-stage renal disease due to Type 2 diabetes are also prone to complications such as hypoglycemia (low blood sugar), infections, or cardiovascular events. Managing these risks – and reducing the need for expensive, acute-care hospitalization – has long been a challenge.
“People with diabetes and chronic kidney disease have a very high risk of complications and experience frequent hospitalizations,” Dr. Lingvay said. “Yet this population is much less likely to be included in clinical trials or be treated with medications that have proven benefits. Our findings demonstrate that GLP1-RAs can lead to fewer cardiovascular events, less progression of kidney disease, and lower health care costs. These are very impactful outcomes that support the widespread benefits of this class of medications in this high-risk population.”
Drs. Zhang and Lingvay believe that their study could help lead to changes in the clinical management of CKD.
“Historically, diabetic kidney disease has been difficult to address,” Dr. Zhang said. “With further research, we could eventually see new guidelines that include GLP1-RAs as part of a comprehensive treatment approach for diabetes-related kidney disease, potentially improving long-term outcomes and enhancing patient quality of life.”
Dr. Lingvay and her colleagues have extensive experience studying the benefits of semaglutide, including its value in reducing the risk of cardiovascular events and its ability to help patients with diabetes or obesity lose weight.
Author disclosures can be found in the manuscript.
About UT Southwestern Medical Center
UT Southwestern, one of the nation’s premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty members have received six Nobel Prizes and include 25 members of the National Academy of Sciences, 23 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 3,200 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 120,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 5 million outpatient visits a year.