Real‐world impact of adding a glucagon‐like peptide‐1 receptor agonist compared with basal insulin on metabolic targets in adults living with type 2 diabetes and chronic kidney disease already treated with a sodium‐glucose co‐transporter‐2 inhibitor: The Impact GLP‐1 CKD study

Abstract Aim To compare the effectiveness of adding a glucagon‐like peptide‐1 receptor agonist (GLP‐1 RA) with adding basal insulin among adults with type 2 diabetes (T2D) and chronic kidney disease (CKD) already treated with a sodium‐glucose co‐transporter‐2 inhibitor (SGLT2i) and not reaching their glycaemic control targets. Methods A retrospective analysis of the Canadian LMC Diabetes Registry was conducted. Adults who initiated a GLP‐1 RA were matched 1:1 to adults who initiated basal insulin in a T2D and CKD population. Changes in metabolic outcomes were evaluated at 26‐52 weeks following the therapy start date. Results Propensity score matching was used to match participants who initiated a GLP‐1 RA to participants who initiated basal insulin ( n = 153/cohort). A significantly greater reduction in HbA1c at 26‐52 weeks of follow‐up was observed in the GLP‐1 RA cohort compared with the basal insulin cohort (−1.3% ± 1.4% vs. −1.1% ± 1.4%, P = .03). Weight was significantly reduced (−3.4 ± 3.7 vs. 2.6 ± 4.5 kg, P < .001), and the estimated glomerular filtration rate decline slowed significantly (−0.3 ± 8.2 vs. −2.4 ± 10.4 mL/min/1.73m 2 , P = .02), but the change in albuminuria was not significantly different (−5.7 ± 38.1 vs. −0.5 ± 38.3 mg/mmol, P = .47) at follow‐up in the GLP‐1 RA group compared with the basal insulin group. No differences in self‐reported hypoglycaemic events per week and therapy discontinuations were reported between the cohorts. Conclusions The study shows the real‐world effectiveness of GLP‐1 RA therapy for T2D and CKD. GLP‐1 RAs provided superior reductions in HbA1c and weight, and greater kidney protection, compared with basal insulin among adults with T2D and CKD already treated with an SGLT2i.