Comparative Outcomes of Newer Antidiabetic Agents in Preventing Diabetic Nephropathy: A Meta-Analysis

Author(s): Gana Ali Ahmad Tahmaz, Asal Ahmed Mohammed Al Azzawi, Aisha Alyassi, Hind Saleh Alhammadi, Asia Abdalla Shaheen Mohamed Abdalla, Qamar Mohammed kashmoola, Dana R.Z Hassouna, Loujain Hussam Subhi nasralla, Amna Ahmed Alteneiji, Sara Ahmed Al Amoodi

Diabetic nephropathy (DN) is known to be one of the central patients' burdens, contributing to the global development of chronic kidney diseases (CKD) and end-stage renal disease (ESRD). Even after the use of non-specific standards such as RAAS inhibitors, the progression of DN remains a challenging clinical problem. Some of the advanced antidiabetic drugs, SGLT2 inhibitors, GLP-1 receptor agonists (GLP-1 RAs), and DPP-4 inhibitors may improve renal function in addition to controlling hyperglycemia. This meta-analysis will compare the clinical efficacy of these newer antidiabetic agents with regard to attaining these objectives, including eGFR decline rate, albuminuria decrease, and the risk of ESRD. Reviews of eligible studies were obtained from PubMed, Embase, Cochrane Library, and Scopus, using keywords related to trial types, including randomised controlled trials (RCTs), cohort studies and meta-analyses with relation to Renal outcome of SGLT2 inhibitors, GLP-1 receptor agonists and DPP-4 inhibitors. Cohen's d was calculated as the measure of effect size, fixed/random as the method of pooling effect sizes and I² as the measure of heterogeneity. The publication bias was assessed by using a funnel plot and Egger's regression test while the sensitivity analyses were done.

SGLT2 inhibitors were also found to have the most substantial nephroprotective benefits, including a reduction of the annual decline of eGFR by 1·4–2·0%, albuminuria by 31–38%, and ESRD risk by 29–34%. A moderate renal benefit was established with GLP-1 receptor agonists inclusive of a decrease in eGFR loss to a range of (-1.2%-1.5%), albuminuria (-24%-28%) and risk of ESRD (-21%- 25%) through anti-inflammatory effects. DPP-4 inhibitors, however, recorded only slight improvement of albuminuria (-9 to -12%) and ESRD (-7 to -10%), making it the worst option for nephroprotection. In line with these findings, this meta-analysis has evidence that SGLT2 inhibitors are superior to other antidiabetic drugs from the renal perspective. Secondly, GLP1-RA and, at last, DPP-4 inhibitors have minimal renal protection. These findings endorse the use of SGLT2 inhibitors to start with for patients having diabetes and CKD, along with GLP-1 receptor agonists, to increase cardiovascular and renal benefits.