The effect of empagliflozin on renal outcomes compared to sitagliptin with type 2 diabetes: target trial emulation using electronic medical records
Abstract
Introduction The renal effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors in diverse populations remain under investigation. While randomized controlled trials have shown renoprotective effects of SGLT2 inhibitors, their impact in routine clinical settings and specific populations such as Koreans requires further evaluation. Aim This study aimed to evaluate the impact of empagliflozin compared to sitagliptin on renal function and related clinical outcomes in patients with type 2 diabetes (T2D) using a target trial emulation approach. Method We conducted a retrospective cohort study using electronic medical records from a Korean tertiary care hospital between 2018 and 2019. New users of empagliflozin or sitagliptin were identified and matched using propensity scores to control for confounding factors. Primary outcomes included changes in estimated glomerular filtration rate (eGFR) and other renal function markers over time. Secondary outcomes included acute kidney injury, albuminuria, and composite renal events, as well as other clinical parameters. A modified intention-to-treat analysis was performed, with follow-up up to 13 months. Results After matching, 219 T2D patients were identified in each group. Empagliflozin was associated with a slower decline in eGFR compared to sitagliptin (p < 0.05). Serum phosphorus levels increased more with empagliflozin (p < 0.05). Empagliflozin showed a non-significant trend toward lower risk of composite renal outcomes (hazard…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 219 participants or records.
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