While there is still no effective long-term treatment for type 2 diabetes (diabetes mellitus), a study published in The New England Journal of Medicine investigated the effects of canagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, on kidney function in type 2 diabetes patients.*

What is the connection between type 2 diabetes and the kidneys?

In people with type 2 diabetes, your blood sugar (glucose) levels are too high, which can damage your kidneys over time. If the kidneys get damaged, they can’t filter out wastes from the blood, resulting in lower kidney function and, ultimately, kidney disease.

Over 34 million Americans (roughly 1 in 10) have diabetes, and of those, approximately 90-95% of them have type 2 diabetes. Moreover, 10% of the world’s total population is affected by chronic kidney disease (CKD). These figures demonstrate the importance of continuing to find effective treatments to stop disease progression and improve bodily functions related to both of these chronic diseases. 

What is a sodium-glucose cotransporter 2 (SGLT2) inhibitor?

Sodium-glucose cotransporter 2 (SGLT2) inhibitors, also referred to as gliflozins, are a type of drug that lowers blood glucose levels. They inhibit, as the name suggests, the reabsorption of glucose into the kidneys, which is what lowers your glucose levels. SGLT2 inhibitors also have cardiovascular benefits and reduce both body weight and blood pressure.

What they did

An international group of researchers and physicians from Australia, The Netherlands, the U.S., and the U.K. combined data for a total of 12,900 patients from 690 sites in 34 countries. People with type 2 diabetes and CKD received canagliflozin, an SGLT2 inhibitor, at a dose of 100 mg daily. Randomly selected similar patients received a placebo (a substance that has no therapeutic effect). The patients were under investigation by physicians for an average time of 2.62 years. 

What they found

The results showed that the risk of kidney failure and cardiovascular events was significantly lower in the canagliflozin group than in the placebo group. 

More specifically, patients in the canagliflozin group had a lower risk of: 

• end-stage kidney disease (ESKD), 
• hospitalization for heart failure, 
• cardiovascular death, 
• myocardial infarction, and 
• stroke. 

What it means

The study’s authors conclude that canagliflozin is an effective treatment option for renal and cardiovascular protection in patients with type 2 diabetes who also have CKD. 

This clinical trial did, however, have a few limitations based on that:

• it was stopped early at a planned interim analysis;
• eGFR levels were not measured for off-treatment patients who completed the trial; and
• patients with very advanced kidney disease, nonalbuminuric or microalbuminuric disease, and kidney diseases believed to be due to conditions other than type 2 diabetes were excluded.

Of these, the most important to make note of is the final limitation regarding what patients were excluded from the trial. Based on this information, “it is not known whether the findings can be generalized to such populations,” as stated in the study.

*Perkovic, V., Jardine, M., Neal, B., Bompoint, S., et. al. (2019, June 13). Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. The New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa1811744