Comparative Effects of Glucose-Lowering Medications on Kidney Outcomes in Type 2 Diabetes

作者：Deborah J. Wexler, Deborah J. Wexler, Ian H. de Boer, Alokananda Ghosh, Naji Younes, Ionut Bebu, Silvio E. Inzucchi, Janet B. McGill, Sunder Mudaliar, David Schade, Michael W. Steffes, William V. Tamborlane, Meng H. Tan, Faramarz Ismail-Beigi, Jill P. Crandall, M. Diane McKee, Stephanie Beringher-Massera, Janet Brown-Friday, Entila Xhori, Keisha Ballentine-Cargill, Sally Duran, H. Estrella, Susana Gonzalez de la torre, Jennifer Lukin, Lawrence S. Phillips, Elizabeth Burgess, Darin E. Olson, Mary K. Rhee, Peter W.F. Wilson, Tasha Stephanie Raines, Johanna Boers, Julie Costello, Maxine Maher-Albertelli, Radhika Mungara, Louise Savoye, CarolAnn White, Chona Gullett, Leah Holloway, Folayan Morehead, Saranjit Person, Mabil Sibymon, Sridhar Tanukonda, Cynthia Adams, April Ross, Ashok Balasubramanyam, Ruchi Gaba, Erica Gonzalez, A. Ideozu, Julizza Jimenez, Gabriela Montes, C. Wright, Priscilla Hollander, Erin Roe, Analyn Jackson, A. Smiley, Polly Burt, Lorie Estrada, Kris Chionh, Faramarz Ismail-Beigi, Corinna Falck-Ytter, Laure Sayyed Kassem, A. K. Sood, Margaret Tiktin, Bethany Cramer, Jacalyn Iacoboni, Maria V. Kononets, Tanya Kulow, Cynthia Newman, Katherine A. Stancil, Cristina Sanders, Lisa Tucker, Amanda Werner, Adrienne Krol, Gloria McPhee, Christine Patel, Linda Colosimo, Audrey Maxwell, Robin Goland, James Pring, L. Alfano, P. Kringas, Camille Hausheer, Jéssica Tejada, Kelly Gumpel, Amanda Kirpitch, Harvey Schneier, Jennifer B. Green, Hiba AbouAssi, Ranee Chatterjee, Mark N. Feinglos, Jennifer English Jones, Shubi A. Khan, J.B. Kimpel, Ronna P. Zimmer, Mary Furst, B.M. Satterwhite, Connie R. Thacker, Kathryn Evans Kreider, Cary N. Mariash, Kieren J. Mather, Heba M. Ismail, Amale Lteif, M. Mullen, T. Hamilton, Nick C. Patel, G. Riera, Marcia Jackson, Vivian Pirics, D. Howard, Danielle Aguillar, S. Hurt, Richard M. Bergenstal, Anders L. Carlson, Thomas Martens, Mary L. Johnson, R. Hill, Jamie Hyatt, C. Jensen, M. Madden, Dianna C. Martin, Holly Willis, Wanda Konerza, Shoua Yang, Rebecca Passi, K. Kleeberger, Stephen P. Fortmann, M. Herson, Karen Mularski, Harry Glauber, J. Prihoda, Britt Ash, Christina Carlson, P.A. Ramey, E. Schield, Britta Torgrimson-Ojerio, Kathy Arnold, Bryan Kauffman, E. Panos, S. Sahnow, K. Bays, Jennifer Cook, J. Gluth, D. Ghioni, K. Schell, Jennifer Criscola, C. Friason, Suzi Jones, С. А. Назаров, Joshua I. Barzilay, N. Rassouli, Rachel Puttnam, Olubukola Ojoawo, R. Nelson, Michelle Curtis, B. Hollis, C. Sanders-Jones, K. Stokes, Z. El-Haqq, A. Kolli, Tú-Anh Tran, Deborah Wexler, Deborah Wexler, Mary Larkin, James B. Meigs, Brittany D. Chambers, Amy Dushkin, Gianna Rocchio, Mike Yepes, Barbara Steiner, H. Dulin, M. Cayford, A. DeManbey, Mallory Hillard, Kimberly Martin, Nopporn Thangthaeng, Lindsey Gurry, R. Kochis, Elyse Raymond, Valerie Ripley, Christine Stevens, Jean Park, Vanita R. Aroda, Adline Ghazi, Michelle Magee, A. Ressing, Amy Loveland, M. Hamm, Maria D. Hurtado, Alexander Kühn, J. Leger, Lumanti Manandhar, F. Mwicigi, Osirelis Sanchez, Theresa Young, Rajesh Garg, V. Lagari-Libhaber, Hermes Flórez, Willy Marcos Valencia, Jennifer Mark, Sabina Casula, Lisset Oropesa-Gonzalez, L. Hue, A. Cuadot, Ramfis Nieto‐Martínez, A.K. Riccio Veliz, M. Gutt, Y.J. Kendal, Bertha Veciana, Andrew Ahmann, Diana Aby-Daniel, Farahnaz Joarder, Victoria Morimoto, C. Sprague, Daisuke Yamashita, Nancy Cady, N. Rivera-Eschright, P. Kirchhoff, Brianna Morales Gonzalez, Joseph Adducci, Аліна Гончарова, Sophia H. Hox, Helen Petrovich, M. Matwichyna, Victoria Jenkins, L Broadwater, R.R. Ishii, N.O. Bermudez, Daniel S. Hsia, William T. Cefalu, Frank L. Greenway, C. Waguespack, Erin King, Greta Fry, Amber Dragg, B. Gildersleeve, Jennifer Arceneaux, Natalie Haynes, A. Thomassie, M. Pavlionis, Brandi Bourgeois, C. Hazlett, Sunder Mudaliar, H Robert, Schafer Boeder, Jeremy Pettus, Elsa Diaz, D. Garcia-Acosta, Sarah Maggs, Catherine DeLue, A. Stallings, Erick Castro, Sylvia Hernandez, Jonathan Krakoff, Jeffrey M. Curtis, Tina Killean, Meshall Khalid, E. Joshevama, E. Diaz, Denelle Martin, K. Tsingine, T. Karshner, Jeanine Albu, F. Xavier Pi‐Sunyer, Sylvaine Frances, Carol A. Maggio, Emily Ellis, Joseph Bastawrose, Xiuqun Gong, Mary Ann Banerji, Phyllis August, Melissa Lee, Daniel Lorber, Brown Necole M., D.H. Josephson, Lorraine L. Thomas, Maria Tsovian, A. Cherian, Marlo H. Jacobson, M.M. Mishko, Sue Kirkman, John B. Buse, J. Dostou, Sriram Machineni, Laura Young, Katherine Bergamo, April Goley, J. B. Kerr, Joseph F. Largay, S. Guarda, J. Cuffee, D. Culmer, Rachael Fraser, Hope Almeida, Samantha Coffer, E. Debnam, L. Kiker, Sarah U. Morton, K. Josey, Gail Fuller, W. Timothy Garvey, Andrea Cherrington, Dana Dyer, M.C.R. Lawson, O. Griffith, April A. Agne, S. McCullars, Robert M. Cohen, Jacqueline Craig, M.C. Rogge, Kathryn Burton, K. Kersey, Carla Wilson, Sonia Lipp, Mary Beth Vonder Meulen, Connie Adkins, T. Onadeko, Neda Rasouli, Chelsea Baker, Emily B. Schroeder, M. Razzaghi, Corey Lyon, Richard Peñaloza, Chantal Underkofler, R. Lorch, Sarah A. Douglass, Stephanie Steiner, William I. Sivitz, Erin Cline, L.K. Knosp, Jennifer McConnell, T. Lowe, William H. Herman, Rodica Pop‐Busui, Meng H. Tan, Catherine L. Martin, Andrea Waltje, Aimee Katona, L. Goodhall, Rebecca Eggleston, Shihchen Kuo, S. Bojescu, Stephanie Bule, N. Kessler, Elizabeth LaSalle, Kelly Whitley, Elizabeth R. Seaquist, A. Bantle, Tasma Harindhanavudhi, Anjali Kumar, Bruce Redmon, John P. Bantle, M. Coe, M. Mech, Abdisa Taddese, Lesia Lesne, Shannon D. Smith, Cyrus Desouza, Lisa Kuechenmeister, Vijay Shivaswamv, S. Burbach, M.G. Rodriguez, K. Seipel, Alissa Alfred, A.L. Morales, J. Eggert, G. Lord, William Taylor, R. Tillson, David S. Schade, Allen Adolphe, Mark R. Burge, Elizabeth Duran-Valdez, Janae Martinez, Anna Bancroft, Susan Kunkel, Fadi Ali Jamaleddin Ahmad, D. Hernandez McGinnis, B. Pucchetti, E. Scripsick, A. Zamorano, Ralph A. DeFronzo, Eugênio Cersósimo, Muhammad Abdul-Ghani, Curtis Triplitt, D. Juarez, Rosa Irene Garza, H. Verastiqui, K. Wright, Curtiss Puckett, Philip Raskin, Chanhaeng Rhee, S. Abraham, L.F. Jordan, S. Sao, L. Morton, Oralenda Smith, Laura Osornio Walker, Laura Schnurr-Breen, R. Ayala, R.B. Kreymer, D. Sturgess, Kristina M. Utzschneider, Steven E. Kahn, Lorena Alarcon-Casas Wright, Edward J. Boyko, Elaine C. Tsiai, Dace Trence, S. Trikudanathan, Basma N. Fattaleh, Brenda K. Montgomery, Karen M. Atkinson, Alexandra Kozedub, Tessa Concepcion, C. Moak, N. Prikhodko, S. Rhothisen, Tom A. Elasy, Stéphanie Martin, Laura Shackelford, R. Goidel, Nina Hinkle, C. Lovell, Janet Myers, J. Lipps Hogan, Janet B. McGill, Maamoun Salam, Toni Schweiger, Sarah Kissel, Carol Recklein, Mary Jane Clifton, William Tamborlane, Anne Camp, Barbara Gulanski, Silvio E Inzucchi, Kim Pham, Michele Alguard, P. Gatcomb, Katarzyna Lessard, Magalys Perez, Lynne Iannone, Elizabeth Magenheimer, Abmaridel Montosa, William T Cefalu, Judith Fradkin, Henry B. Burch, Andrew A. Bremer, David M. Nathan, John M. Lachin, Heidi Krause‐Steinrauf, Naji Younes, Ionut Bebu, Nicole M. Butera, C.J. Buys, Anna Fagan, Yuping Gao, Alokananda Ghosh, M.R. Gramzinski, Stephanie D. Hall, Erin Kazemi, Elizabeth Legowski, Haiyin Liu, Colleen E. Suratt, Mark Tripputi, A. Arey, Michael Backman, Joel Bethepu, Claire Lund, P. Mangat Dhaliwal, Paula McGee, E. Mesimer, Lisa Ngo, Michael Steffes, Jesse C. Seegmiller, Amy K. Saenger, Valerie Arends, Deanna Gabrielson, T. Conner, Stuart Warren, Jolene Day, Jeffrey Huminik, Alexandra Scrymgeour, Elsayed Z. Soliman, Yashashwi Pokharel, Zhu‐Ming Zhang, Charles Campbell, Julie Hu, Lisa Keasler, Susan Hensley, Yabing Li, Rada Mihalcea, Do June Min, Verónica Pérez‐Rosas, Lisa A. Prosser, Ken Resnicow, Wen Ye, Hui Shao, Ping Zhang, José A. Luchsinger, Danurys Sanchez, Stephanie Assuras, Erik J. Groessl, F. Sakha, Helen Chong, Naomi Hillery, I. Abdouch, Gul Bahityar, P. Brantley, Frances E. Broyles, G. Canaris, Paul M. Copeland, Jeri J. Craine, W.L. Fein, A. Gliwa, Lisel M. Hope, Melissa S. Lee, R. Meiners, Vaughn Meiners, Hollis R. O’Neal, James E. Park, Alan Sacerdote, E. Sledge, L. Soni, Jeanne Steppel-Reznik, Alexander Turchin · 发表于：JAMA Internal Medicine · 年份：2023 · DOI：10.1001/jamainternmed.2023.1487 · 被引用次数：39 · 研究领域：Diabetes Treatment and Management、Chronic Kidney Disease and Diabetes、Metabolism, Diabetes, and Cancer

Importance: Type 2 diabetes (T2D) is the leading cause of kidney disease in the US. It is not known whether glucose-lowering medications differentially affect kidney function. Objective: To evaluate kidney outcomes in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness (GRADE) trial comparing 4 classes of glucose-lowering medications added to metformin for glycemic management in individuals with T2D. Design, Setting, and Participants: A randomized clinical trial was conducted at 36 sites across the US. Participants included adults with T2D for less than 10 years, a hemoglobin A1c level between 6.8% and 8.5%, and estimated glomerular filtration rate (eGFR) greater than or equal to 60 mL/min/1.73 m2 who were receiving metformin treatment. A total of 5047 participants were enrolled between July 8, 2013, and August 11, 2017, and followed up for a mean of 5.0 years (range, 0-7.6 years). Data were analyzed from February 21, 2022, to March 27, 2023. Interventions: Addition of insulin glargine, glimepiride, liraglutide, or sitagliptin to metformin, with the medication combination continued until the HbA1c was greater than 7.5%; thereafter, insulin was added to maintain glycemic control. Main Outcomes and Measures: Chronic eGFR slope (change in eGFR between year 1 and trial end) and a composite kidney disease progression outcome (albuminuria, dialysis, transplant, or death due to kidney disease). Secondary outcomes included incident eGFR less than 60 mL/min/1.73...