A Real‐World Cohort Study on the Association of the Use of Sodium‐Glucose Cotransporter‐2 Inhibitor With the Incidence of Chronic Kidney Disease (CKD) in Patients With Type 2 Diabetes Mellitus Without CKD.

<h2 id="Aim">Aim</h2><ul><li>To evaluate whether SGLT2 inhibitor (SGLT2i) use is associated with a lower incidence of chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) but no pre-existing CKD.</li><li>To assess the association of SGLT2i use with long-term changes in eGFR and urinary albumin-to-creatinine ratio (uACR) in a multi-ethnic Southeast Asian population.</li></ul><h2 id="Method">Method</h2><ul><li>Retrospective, real-world cohort study using the SingHealth Diabetes Registry, Singapore during period of 2016–2023.</li><li><strong>Population:</strong> 21,780 adults with T2D, age ≥21 years and preserved kidney function with eGFR ≥60 mL/min/1.73 m² and uACR &lt;30 mg/g.</li><li>4,450 patients were included: 2,225 SGLT2i users and 2,225 non-SGLT2i users.</li><li>Matching included key variables such as age, sex, housing type, BMI, HbA1c, baseline eGFR, ischemic heart disease, and selected concomitant medications.</li><li><strong>Primary outcome:</strong> Incident CKD, defined as sustained:<ul><li>eGFR &lt;60 mL/min/1.73 m², or</li><li>uACR &gt;30 mg/g, with consecutive readings &gt;90 days apart.</li></ul></li><li><strong>Secondary outcomes:</strong> Longitudinal changes in eGFR and uACR.</li></ul><h2 id="Results">Results</h2><ul><li>SGLT2i use was associated with lower CKD incidence, slower decline in kidney function, and lower increase in albuminuria (Table 1).</li></ul><p><strong>Table 1. Renal Outcomes with SGLT2i Use</strong></p><p style="text-align:center;"><img src="https://cdn.megawecare.com/GHBY/Internal-Images/1791870525566-2effc4b1a5d2-Screenshot_2026-10-13_105857.webp" alt="Renal Outcomes with SGLT2i Use" width="981" height="440"></p><ul><li>In longitudinal analysis, there is a significant interaction between SGLT2i use and time, suggesting a time-dependent effect (p value &lt; 0.001) for change in eGFR (Fig. 1) and uACR (Fig. 2) over time with SGLT2i use.</li></ul><p><strong>Figure 1. Change in eGFR over time</strong>&nbsp;</p><p style="text-align:center;"><img src="https://cdn.megawecare.com/GHBY/Internal-Images/1791869500786-adf6620326e1-Screenshot_2026-10-13_110101.webp" alt="Change in eGFR over time" width="499" height="371"></p><p style="text-align:center;"><img src="https://cdn.megawecare.com/GHBY/Internal-Images/1791869589072-eff832dc5ff8-Screenshot_2026-10-13_110232.webp" alt="table" width="1134" height="132"></p><p><strong>Figure 2. Change in uACR over time.</strong></p><figure class="image"><img style="aspect-ratio:723/525;" src="https://cdn.megawecare.com/GHBY/Internal-Images/1791869880992-b1d0e8df4d81-Screenshot_2026-10-13_110349.webp" alt="Change in uACR over time." width="723" height="525"></figure><p style="text-align:center;"><img src="https://cdn.megawecare.com/GHBY/Internal-Images/1791870048685-f0e9e4649ca5-Screenshot_2026-10-13_110845.webp" alt="table" width="1088" height="127"></p><h2 id="Conclusion" data-section="conclusion">Conclusion</h2><ul><li>In patients with T2D and preserved renal function, SGLT2i use was associated with:<ul><li>Lower incidence of CKD</li><li>Slower decline in eGFR</li><li>Smaller increase in uACR over time</li></ul></li><li>The findings support a potential role for SGLT2 inhibitors in primary prevention of CKD among patients with T2D who have not yet developed CKD.</li><li>The study provides real-world evidence from a multi-ethnic Asian population with T2D and preserved renal function.</li><li>The authors suggest that earlier SGLT2i initiation may provide greater renal protection.</li></ul><p><i><strong>Disclaimer:</strong> This scientific information content is facilitated by Mega Lifesciences and is intended for healthcare professionals for their reading and update. Although care has been taken in compiling and checking the information, the facilitator is not responsible, or in any way liable for any errors, omissions or inaccuracies in this content whether arising from negligence or otherwise, however, or for any consequences arising therefrom.</i></p>

6dfa5db4d19d Diabetes Update   Issue 5   Sept 2026   Final

<ol dir="ltr"><li><a href="#Aim">Aim</a></li><li><a href="#Method">Method</a></li><li><a href="#Results">Results</a></li><li><a href="#Conclusion">Conclusion</a></li></ol>