Emerging Trends and Clinical Impacts of SGLT2 Inhibitors and GLP-1 Receptor Agonists in Diabetes and Kidney Care
SGLT2 inhibitors and GLP-1 receptor agonists have reshaped cardiorenal management for patients with chronic kidney disease (CKD) and type 2 diabetes; recent data confirm this therapeutic shift is now clinically consequential. Prescriptions rose steadily between 2012 and 2023, aligning with expanding evidence for renal and cardiovascular benefit.
A nationwide US observational cohort analysis using commercial and Medicare Advantage claims evaluated new users between 1 January 2012 and 30 September 2023 and demonstrates a substantial rise in prescriptions of SGLT2 inhibitors and GLP-1 RAs over the study interval. Prespecified endpoints were primarily prescribing outcomes — incidence of new users and treatment-pattern metrics — with secondary descriptive reporting of clinical events captured in claims (for example, hospitalizations for heart failure and sustained eGFR decline). The report emphasizes cohort counts (later-period SGLT2i n=94,080; GLP-1 RA n=72,816) and temporal trends rather than presenting adjusted comparative-effect estimates for clinical endpoints.
Subgroup analyses show heterogeneous uptake by age and kidney-function strata and document demographic variation in the observed trends, as described in the study on treatment patterns 2012–2023. The paper provides subgroup counts and percentages (for example, the later-period SGLT2i cohort included 94,080 new users, and the proportion with stage 3 CKD rose by roughly 8–10 percentage points compared with the earlier period), and notes that formal statistical comparisons in some strata were limited by missing eGFR/uACR data; where inferential results were reported they were presented as adjusted rate or odds ratios rather than causal comparative-effect estimates.
New-user profiles shifted: compared with the earlier period, later-period SGLT2i recipients were older (mean 73.1 vs 68.6 years) with higher congestive heart failure prevalence (35.9% vs 21.5%), while GLP-1 RA new users also trended older (mean 70.0 vs 67.9 years) with greater prior SGLT2i exposure and less insulin use. The later cohorts showed more severe kidney dysfunction (stage 3 proportions rose markedly) and a shift toward add-on prescribing to ACEi/ARB, with combination use in a minority of patients. These shifts imply greater baseline cardiovascular comorbidity and renal impairment among recipients and signal the need for tailored baseline monitoring and follow-up plans.
Practical barriers and opportunities continue to shape adoption: cost, prior-authorization requirements, and historical renal-function exclusions remain operational constraints, whereas broadened FDA indications and the 2022 KDIGO recommendation updates have expanded eligibility and provided momentum for uptake. Policy and formulary changes that reduced administrative friction and clarified renal-use thresholds likely accelerated adoption; conversely, persistent data gaps (for example, missing eGFR/uACR) and benefit–risk uncertainty in some subgroups limit universal application. Attention to authorization processes, laboratory capture, and integrated care pathways will determine implementation success.