Nikhil Prasad Fact checked by:Thailand Medical News Team May 06, 2025 2 hours, 54 minutes ago
Medical News: A major international research team has just completed a groundbreaking study evaluating the safety and effectiveness of three popular classes of drugs used to treat diabetic kidney disease (DKD), a common and serious complication of diabetes. The results offer clear guidance on which medications work best—and which ones may cause more harm than good.
New Study Reveals Which Diabetes Drugs Help or Harm Your Kidneys!
Researchers from the School of Pharmacy at Fudan University, the Shanghai Fifth People’s Hospital (Fudan University), Xiyuan Hospital at the China Academy of Chinese Medical Sciences, the Heilongjiang Academy of Chinese Medicine Sciences, and the Affiliated Huishan Hospital of Xinglin College at Nantong University collaborated on the study, which reviewed data from 35 randomized clinical trials involving 24930 patients.
The team used a statistical approach called Bayesian network meta-analysis to directly compare three types of drugs: sodium-glucose co-transporter 2 inhibitors (SGLT-2i), dipeptidyl peptidase-4 inhibitors (DPP-4i), and glucagon-like peptide-1 receptor agonists (GLP-1RA). These medications are increasingly used to manage DKD, but their safety and effectiveness had never been systematically compared before. This
Medical News report breaks down the findings for everyday readers.
Clear Winners and Losers Among the Drugs
Among the most important findings, GLP-1RA drugs like semaglutide (Sem) 14 mg were the most effective at reducing blood sugar, body weight, and blood pressure. However, they also had the highest risk of side effects like gastrointestinal problems and hypoglycemia.
SGLT-2 inhibitors like empagliflozin (Emp) 25 mg showed a strong balance between safety and moderate effectiveness. They were linked with fewer side effects, including reduced risks of cardiovascular problems and hypoglycemia, making them a potentially ideal choice for long-term use.
DPP-4 inhibitors such as vildagliptin (Vil) 50 mg had the weakest blood sugar-lowering effect but were generally well tolerated, with the fewest overall side effects. This suggests they may be safer for certain patients, especially those with advanced kidney disease or multiple health problems.
Ranking the Top Drugs
The researchers used a special scoring system known as SUCRA to rank each drug's performance. Some highlights include:
-Best for reducing HbA1c (blood sugar marker): Vildagliptin 50 mg
-Best for lowering fasting blood sugar: Albiglutide 30 mg
-Best for weight loss: Semaglutide 14 mg
-Best for reducing blood pressure: Semaglutide 14 mg
-Best overall safety: Sitagliptin 25/50 mg and Albiglutide 30 mg
Interestingly, some drugs performed well in certain areas but poorly in others. For example, semaglutide 14 mg was highly effective but also had one of the highest risks of hypog
lycemia and gastrointestinal side effects. Meanwhile, drugs like linagliptin 5 mg had relatively low effectiveness but were linked to higher risks of fractures and hypovolemia (low blood volume).
Key Safety Findings
The study also looked at serious safety issues, including risk of:
-Amputation: Dapagliflozin + saxagliptin combination had the highest risk
-Acute kidney injury (AKI): Sitagliptin 100 mg raised AKI risk significantly
-Cardiovascular events (MACE): Semaglutide 1.0 mg (injected) and bexagliflozin showed the highest risks
-Urinary and reproductive infections: Semaglutide 14 mg and valsartan 80 mg had the lowest risks
-Fractures: Albiglutide 30 mg had the highest fracture risk
What This Means for Patients
This comprehensive review is the first of its kind and offers a roadmap for doctors and patients trying to choose the best medication for diabetic kidney disease. While GLP-1 receptor agonists offer powerful blood sugar control, they come with significant side effect risks. SGLT-2 inhibitors may provide a better balance of safety and effectiveness, especially for those with a history of heart or kidney issues. DPP-4 inhibitors, though less effective, might be the safest option for some individuals.
Conclusion
This study presents a detailed and unbiased comparison of the three major classes of drugs used to treat diabetic kidney disease. It highlights that while GLP-1 receptor agonists offer the most potent benefits in terms of blood sugar, weight, and blood pressure reduction, they also pose the highest risks of serious side effects. SGLT-2 inhibitors appear to strike the best balance between effectiveness and safety, making them a strong choice for many patients. DPP-4 inhibitors may be best reserved for those who are highly sensitive to side effects or who require a gentler treatment approach. The findings support personalized treatment decisions based on a patient’s individual health profile, kidney function, and cardiovascular risk.
The study findings were published on a preprint server and are currently being peer reviewed.
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=5213389
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Medical News.
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