Diabetes Metab J.  2020 Aug;44(4):489-497. 10.4093/dmj.2020.0172.

Sodium-Glucose Cotransporter-2 Inhibitor for Renal Function Preservation in Patients with Type 2 Diabetes Mellitus: A Korean Diabetes Association and Korean Society of Nephrology Consensus Statement

• Oh TJ
• Moon JY
• Hur KY
• Ko SH
• Kim HJ
• Kim T
• Lee DW
• Moon MK
• The Committee of Clinical Practice Guideline
• Korean Diabetes Association and Committee of the Cooperative Studies
• Korean Society of Nephrology

• KMID: 2513009
• DOI: http://doi.org/10.4093/dmj.2020.0172

Abstract

Diabetes is a leading cause of end-stage renal disease. Therefore, prevention of renal dysfunction is an important treatment goal in the management of diabetes. The data of landmark cardiovascular outcome trials of sodium-glucose cotransporter-2 (SGLT2) inhibitor showed profound reno-protective effects. The Korean Diabetes Association and the Korean Society of Nephrology reviewed clinical trials and performed meta-analysis to assess the effects of SGLT2 inhibitors on the preservation of estimated glomerular filtration rate (eGFR). We limited the data of SGLT2 inhibitors which can be prescribed in Korea. Both eGFR value and its change from the baseline were significantly more preserved in the SGLT2 inhibitor treatment group compared to the control group after 156 weeks. However, some known adverse events were increased in SGLT2 inhibitor treatment, such as genital infection, diabetic ketoacidosis, and volume depletion. We recommend the long-term use SGLT2 inhibitor in patients with type 2 diabetes mellitus (T2DM) for attenuation of renal function decline. However, we cannot generalize our recommendation due to lack of long-term clinical trials testing reno-protective effects of every SGLT2 inhibitor in a broad range of patients with T2DM. This recommendation can be revised and updated after publication of several large-scale renal outcome trials.

Keyword

Diabetes mellitus, type 2; Glomerular filtration rate; Sodium-glucose transporter 2 inhibitors

Figure

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  Fig. 1 Effect of sodium-glucose cotransporter-2 (SGLT2) inhibitors on (A) estimated glomerular filtration rate (eGFR), and (B) change of eGFR from baseline. SD, standard deviation; IV, inverse variance; CI, confidence interval.

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  Fig. 2 Effect of sodium-glucose cotransporter-2 (SGLT2) inhibitors on change of (A) glycosylated hemoglobin, (B) body weight, (C) systolic blood pressure, and (D) diastolic blood pressure. SD, standard deviation; IV, inverse variance; CI, confidence interval.

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  Fig. 3 Effect of sodium-glucose cotransporter-2 (SGLT2) inhibitors on (A) hypoglycemia, (B) urinary tract infection, (C) genital infection, (D) diabetic ketoacidosis, (E) acute kidney injury, and (F) volume depletion. M-H, Mantel-Haenszel; CI, confidence interval.

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  Fig. 4 Results of patients with estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2. Effect of sodium-glucose cotransporter-2 (SGLT2) inhibitors on (A) eGFR, and (B) change of eGFR from baseline. SD, standard deviation; IV, inverse variance; CI, confidence interval.

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  Fig. 5 Result of Asian dominant studies. Effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors on change of (A) estimated glomerular filtration rate and (B) glycosylated hemoglobin. SD, standard deviation; IV, inverse variance; CI, confidence interval.

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