eGFR within normal range predictive of SGLT2 inhibitor response
medwireNews: Kidney function predicts patients’ response to sodium-glucose cotransporter (SGLT)2 inhibitors even in patients with normal estimated glomerular filtration rate (eGFR), show real-world data.
Robert Kimmitt (Royal Devon and Exeter Hospital, UK), who presented the findings at the 2018 Diabetes UK Professional Conference in London today, said that this could help physicians to choose between possible second-line medications among patients with poor glycemic control on metformin monotherapy.
Using data from the UK Clinical Practice Research Datalink, the researchers found a linear relationship for glycated hemoglobin (HbA1c) response across the range of preserved eGFR, whereby each 10-unit increase in eGFR was associated with a 1.2 mmol/mol greater reduction in HbA1c during patients’ first 6 months of using an SGLT2 inhibitor.
This was “an enduring trend,” said Kimmitt, reporting a still significant, albeit weaker, association after 12 months of use, with each 10-unit eGFR increase associated with a 0.9 mmol/mol larger reduction in HbA1c.
There were 2791 patients in the study, who were aged an average of 60 years and had a mean diabetes duration of 9 years. Kimmitt noted that these real-world data are in line with findings from clinical trials of SGLT2 inhibitors. In contrast to this relationship, there was no association between eGFR and response to dipeptidyl peptidase-4 inhibitors in 14,433 patients taking these medications, he reported.
However, although patients with better eGFR can be expected to have the best glycemic response to SGLT2 inhibitors, Kimmitt noted that there are also arguments for using these medications in patients with poor renal function, because of their reported renoprotective effects.
He additionally stressed that patients with the best renal function may also be those who excrete the most glucose in their urine and therefore experience the worst thirst and be least willing to continue taking the medication. “We don’t know that’s the case, but we need to look for it, because if you can’t disentangle efficacy from the adverse effects it’s going to limit the use of this kind of stratification approach,” he said.
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