Kidney outcomes with GLP-1 receptor agonists in people with type 2 diabetes already receiving SGLT2 inhibitors: a target trial emulation study using UK primary care data

作者：Thijs T Jansz, Andrew P McGovern, Katherine Young, Martha M Dinsdale, Pedro Cardoso, Beverley M Shields, Andrew T Hattersley, Angus G. Jones, Ewan R. Pearson, Coralie Bingham, Richard A Oram, John M Dennis · 发表于：The Lancet Primary Care · 年份：2026 · DOI：10.1016/j.lanprc.2026.100139 · 被引用次数：1 · 研究领域：Diabetes Treatment and Management、Chronic Kidney Disease and Diabetes、Diabetes Management and Research

Background Type 2 diabetes is the leading cause of kidney failure and is predominantly managed in primary care. Large randomised trials have shown that GLP-1 receptor agonists and SGLT2 inhibitors each slow kidney disease progression, but their combined effect on kidney outcomes remains unclear. We aimed to evaluate the comparative effectiveness of GLP-1 receptor agonists versus DPP-4 inhibitors or sulfonylureas on kidney outcomes in individuals with type 2 diabetes already receiving SGLT2 inhibitor treatment. Methods In this observational study, we emulated a pragmatic target trial using an active-comparator, new-user cohort design with UK primary care electronic health record data (Clinical Practice Research Datalink, March 31, 2013–March 31, 2023) with linkage to hospital inpatient, deprivation, and mortality data. We included individuals with type 2 diabetes already receiving SGLT2 inhibitors who newly initiated either GLP-1 receptor agonists or comparator drugs DPP-4 inhibitors or sulfonylureas. We excluded those with estimated glomerular filtration rate (eGFR) of less than 20 mL/min per 1·73 m 2 or end-stage kidney disease. Individuals in the comparator group who initiated a GLP-1 receptor agonist during follow-up were censored at the date of GLP-1 receptor agonist initiation and subsequently re-entered into the GLP-1 receptor agonist group. We followed up all initiations regardless of subsequent treatment discontinuation (intention-to-treat analysis), with a maximum fo...