Medications for type 2 diabetes and chronic kidney disease

Diabetes Medications That Directly Benefit the Kidneys

The U.S. Food and Drug Administration (FDA) has approved two classes of drugs for the management of type 2 diabetes that have direct and significant beneficial effects on kidney health: sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists.

SGLT2 inhibitors

SGLT2 inhibitors are daily pills that block your body’s ability to reabsorb sugar (glucose) from your blood, causing excess sugar to be passed out through your urine.

SGLT2 inhibitors can be prescribed to people in most stages of CKD, including those with advanced kidney disease or at high risk of kidney failure: “People who have advanced CKD but are not yet on dialysis may also benefit,” says Alexander Turchin, MD, director of diabetes quality at Brigham and Women’s Hospital and professor associate professor at Harvard Medical School in Boston, Massachusetts.

It is less clear whether or not SGLT2 inhibitors protect kidney health in people who have not yet developed measurable kidney disease, because this has not yet been rigorously tested. “But, based on what we know so far, one would reasonably expect that their use would have benefits for kidney health,” says Dr. Turchin.

Commercially available SGLT2 inhibitors approved for the treatment or prevention of kidney disease include:

• canagliflozin (Invokana)
• dapagliflozin (Farxiga)
• empagliflozin (Jardiance)

• Dehydration
• Urinate more often
• Yeast infections and urinary tract infections (UTIs)
• Low blood pressure
• Low blood sugar

GLP-1 receptor agonists

GLP-1 receptor agonists are best known as blockbuster drugs for diabetes and obesity. They mimic a hormone that triggers the release of insulin from your pancreas to support digestion and slow the release of glucose from your liver to control blood sugar levels. They also increase your feeling of fullness after meals and slow down digestion.

Although the evidence for kidney protection may be stronger for SGLT2 inhibitors than for GLP-1, it is unclear whether one drug is more effective than the other: “No one has compared them directly to each other, but SGLT2 inhibitors appear to be more effective in preventing [the] progression of kidney disease than GLP1,” explains Turchin.

And it’s possible to take both at the same time, he says. “I wouldn’t generally consider this a choice between the two. As far as we know, combining the two classes of drugs may result in greater benefit – although, again, testing has not yet examined this. I generally recommend that my patients with kidney disease take both to prevent progression of the disease as much as possible.”