OBJECTIVE To assess whether sodium-glucose cotransporter-2 inhibitor (SGLT2i) therapy is associated with a favorable renal prognosis for patients with type 2 diabetes melllitus (T2DM) outside the clinical trials setting. PARTICIPANTS AND METHODS This retrospective study analyzed routinely collected health care records of ∼160 medical institutions in Japan from April 1, 2014, to December 31, 2017/2018 (varying at the institutional level). Adults with T2DM but without end-stage renal disease who initiated either SGLT2i or other classes of glucose-lowering medications (o-GLM) were matched using propensity score. The primary outcome was the time course of estimated glomerular filtration rate (eGFR) displayed in spline curve. The composite of renal worsening (>40% decline in eGFR) and the development of eGFR<30 mL/1.73 m2 per minute was evaluated as a secondary outcome. Two sensitivity analyses were conducted to determine the robustness of results. RESULTS We compared a matched cohort of 1433 SGLT2i users and 2739 o-GLM users (mean age: 61 years). The eGFR declined over time in both groups during the observation period (median: 17 months; maximum: 54 months), with a slower eGFR slope observed in SGLT2i users. This slower decline was consistently observed across different SGLT2i agents and different baseline eGFR groups. The cumulative incidence of composite renal endpoints was lower in the SGLT2i group with a hazard ratio of 0.70 (95% CI, 0.50-0.98; P=.039). Those findings were consistent in sensitivity analyses limited to the period adherent to the initial drug regimen and with a different approach for propensity score calculation. CONCLUSION In a matched cohort of T2DM patients, SGLT2i use was associated with preserved renal function relative to o-GLM use over 2 to 4 years.

中文翻译：

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钠葡萄糖共转运蛋白2抑制剂与其他类型的降糖药物对2型糖尿病肾结局的比较有效性。

目的评估在临床试验范围之外，2型糖尿病患者（T2DM）的钠葡萄糖共转运蛋白2抑制剂（SGLT2i）治疗是否与良好的肾脏预后相关。参与者和方法这项回顾性研究分析了2014年4月1日至2017/2018年12月31日在日本约160家医疗机构的常规医疗记录（在机构水平上有所不同）。使用倾向性得分对开始SGLT2i或其他类别的降糖药物（o-GLM）的患有T2DM但没有终末期肾脏疾病的成人进行匹配。主要结果是样条曲线中显示的估计肾小球滤过率（eGFR）的时间过程。肾脏恶化（eGFR下降> 40％）和eGFR形成<30 mL / 1的复合物。每分钟73平方米被评估为次要结果。进行了两次敏感性分析，以确定结果的稳健性。结果我们比较了1433名SGLT2i用户和2739名o-GLM用户（平均年龄：61岁）的匹配队列。观察期内，两组的eGFR随时间下降（中位数：17个月；最大：54个月），SGLT2i用户的eGFR斜率较慢。在不同的SGLT2i药物和不同的基线eGFR组中一致观察到这种较慢的下降。SGLT2i组中复合肾终点的累积发生率较低，危险比为0.70（95％CI，0.50-0.98； P = .039）。这些发现在敏感性分析中是一致的，仅限于最初药物治疗方案所遵循的时期，并且使用不同的倾向得分计算方法。