Comparative Effects of Glucose-Lowering Drugs on Adverse Kidney Outcomes

In the landmark GRADE trial (NEJM JW Gen Med Oct 15 2022 and N Engl J Med 2022; 387:1075), researchers compared kidney outcomes in 5000 people (mean age, 57) with type 2 diabetes who were taking metformin and who were randomized to one of four add-on therapies: insulin glargine, glimepiride (a sulfonylurea), liraglutide (a glucagon-like peptide-1–receptor agonist), or sitagliptin (a dipeptidyl peptidase-1 inhibitor). The original published report showed no difference between groups in renal outcomes at 5 years; now, researchers have provided additional detail.

At baseline, mean glycosylated hemoglobin (HbA_1c) was 7.5%, mean duration of diabetes was 4.2 years, and mean estimated glomerular filtration (eGFR) was 95 mL/minute/1.73 m²; only 2.5%…