Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors Offer Enhanced Kidney Protection, Especially in Patients With Higher Body Mass Index (BMI)
SOURCE: Radcliffe CVRM
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Sodium-glucose cotransporter-2 (SGLT2) inhibitors significantly slow kidney function decline in patients with type 2 diabetes, with even greater benefits seen in those with higher body mass index (BMI), according to a nationwide Japanese study published recently.1  

 

Researchers analyzed data from 2,165 patients prescribed SGLT2 inhibitors compared with 4,330 matched patients on dipeptidyl peptidase-4 (DPP4) inhibitors. Over an eight-year period (2014-2022), they found: 

  • A significantly slower decline in kidney function estimated glomerular filtration rate [eGFR]) in patients treated with SGLT2 inhibitors compared to those receiving DPP4 inhibitors (−1.34 vs. −1.49 mL/min/1.73 m²/year; P<0.0001).
  • Enhanced protective effects of SGLT2 inhibitors in patients with higher BMI, particularly overweight or obese individuals (interaction P=0.0017).
  • Consistent findings even when the study defined kidney decline as a 30% or 40% reduction in eGFR. 

 

The authors suggest that obesity-related kidney hyperfiltration could explain the greater benefit observed in patients with higher BMI. Lead researcher Dr Takahiro Jimba from The University of Tokyo commented, “Our findings underscore the importance of BMI assessment to optimize treatment strategies for kidney protection in type 2 diabetes.” 

 

The findings support current guideline recommendations, such as those from the American Diabetes Association (ADA), advocating the use of SGLT2 inhibitors for patients with type 2 diabetes and chronic kidney disease (CKD).2 However, a notable limitation of this observational study is its retrospective design, which could introduce selection bias despite propensity-score matching. Further prospective, randomized trials are necessary to conclusively define the impact of BMI on the effectiveness of SGLT2 inhibitors. 

 

References 

  1. Jimba T, Kaneko H, Suzuki Y, et al. Effect of SGLT2i on kidney outcomes of individuals with type 2 diabetes according to body mass index: nationwide cohort study. Eur Heart J Cardiovasc Pharmacother. 2025; 11(2):155-163. doi: 10.1093/ehjcvp/pvae094. PMID: 39895498
  2. American Diabetes Association Professional Practice Committee. 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes-2025. Diabetes Care. 2025 Jan 1;48(Supplement_1):S239-S251. doi: 10.2337/dc25-S011. PMID: 39651975 

 

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