Open AccessConcomitant treatment with insulin and sodium–glucose cotransporter 2 inhibitors was associated with the renal composite outcome in Japanese patients with type 2 diabetes and chronic kidney disease: A propensity score‐matched analysis
Author(s) -
Toyoda Masao,
Saito Nobumichi,
Kimura Moritsugu,
Hatori Nobuo,
Tamura Kouichi,
Miyakawa Masaaki,
Sato Kazuyoshi,
Kanamori Akira,
Kobayashi Kazuo
Publication year - 2022
Publication title -
journal of diabetes investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.089
H-Index - 50
eISSN - 2040-1124
pISSN - 2040-1116
DOI - 10.1111/jdi.13825
Subject(s) - medicine , renal function , kidney disease , diabetes mellitus , albuminuria , concomitant , propensity score matching , type 2 diabetes , hazard ratio , creatinine , gastroenterology , surgery , urology , endocrinology , confidence interval
Aims/Introduction We previously reported that sodium–glucose cotransporter 2 inhibitor (SGLT2i) treatment was associated with an improvement of the albumin‐to‐creatinine ratio in Japanese patients with type 2 diabetes mellitus and chronic kidney disease. The present study clarified how concomitant insulin treatment (IT) with SGLT2i therapy influences the renal composite outcome (RCO). Materials and Methods We retrospectively evaluated 624 Japanese patients with type 2 diabetes mellitus and chronic kidney disease who underwent SGLT2i treatment. The renal composite outcome was set as progression of the stage of albuminuria or a ≥15% decrease in the estimated glomerular filtration rate per year. We developed a cohort model of patients managed with and without IT (Ins [+], Ins [−]) using propensity score matching methods. Furthermore, all patients in our study population were stratified into quintiles according to their propensity score. Results The incidence of the RCO was in Ins (+) patients significantly higher than that in Ins (−) ( P = 0.033). The estimated hazard ratio for the RCO was 1.55 ( P = 0.035) in Ins (+) patients. The change in the estimated glomerular filtration rate and albumin‐to‐creatinine ratio in the groups was not statistically significant. The analysis, which was based on the quintiles, showed a statistically significant difference between the Ins (+) and Ins (−) groups ( P = 0.01); the odds ratio for the RCO in patients managed with IT was 2.20 ( P = 0.01). Conclusions Concomitant administration of IT with SGLT2is influenced the RCO in Japanese patients with type 2 diabetes mellitus and chronic kidney disease. We might need to consider the influence of concomitant agents on the renoprotective effects of SGLT2i therapy.