Evidence map›Paper›PMID 41574952›Full record

ArticleDiabetes, obesity & metabolism2026

SGLT2 inhibitors and mortality in older adults with diabetic kidney disease: A target trial emulation study.

Tatsuhiko Azegami, Hidehiro Kaneko, Akira Okada, Yuta Suzuki, Toshiyuki Ko, Kazuki Aoyama, Takashin Nakayama, Yuya Kimura, Katsuhiko Fujiu, Norifumi Takeda and 7 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Diabetes, obesity & metabolism, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Tatsuhiko AzegamiDivision of Nephrology, Endocrinology, and Metabolism, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Hidehiro KanekoDepartment of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.ORCID 0000-0003-2553-6170
Akira OkadaDepartment of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.ORCID 0000-0001-6480-3388
Yuta SuzukiDepartment of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Toshiyuki KoDepartment of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Kazuki AoyamaDivision of Nephrology, Endocrinology, and Metabolism, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Takashin NakayamaDivision of Nephrology, Endocrinology, and Metabolism, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Yuya KimuraDepartment of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Katsuhiko FujiuDepartment of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Norifumi TakedaDepartment of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Hiroyuki MoritaDepartment of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Takashi YokooDivision of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
Koichi NodeDepartment of Cardiovascular Medicine, Saga University, Saga, Japan.ORCID 0000-0002-2534-0939
Masaomi NangakuDivision of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
Norihiko TakedaDepartment of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Hideo YasunagaDepartment of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Kaori HayashiDivision of Nephrology, Endocrinology, and Metabolism, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.

Funding

Ministry of Education, Culture, Sports, Science and Technology, Japan 20H03907Ministry of Education, Culture, Sports, Science and Technology, Japan 21H03159Ministry of Education, Culture, Sports, Science and Technology, Japan 21K08123Ministry of Health, Labour, and Welfare 23AA2003
6 · The paper itself

Abstract

aimsRandomized controlled trials on sodium-glucose cotransporter 2 (SGLT2) inhibitors have yielded inconsistent findings regarding mortality benefits. It remains unclear whether, and in which subgroups, SGLT2 inhibitors confer survival benefits in older adults with diabetic kidney disease (DKD). MATERIALS AND

methodsWe emulated a target trial using a nationwide claims and health checkup database in Japan to compare all-cause mortality between SGLT2 and dipeptidyl peptidase-4 (DPP4) inhibitor initiators among 5371 adults aged ≥65 years with DKD. The primary outcome was all-cause mortality. Hazard ratios (HRs) were estimated using propensity score overlap weighting and Cox proportional hazards models in an intention-to-treat analysis. A per-protocol analysis with inverse probability of censoring weighting was conducted as sensitivity analysis. Effect modification by age, body mass index (BMI) and Charlson comorbidity index (CCI) was assessed using restricted cubic spline models.

resultsDuring a median follow-up of 2.23 (IQR, 1.07-3.49) years, 437 deaths occurred. SGLT2 inhibitor use was associated with significantly lower all-cause mortality than DPP4 inhibitors (HR, 0.51; 95% confidence interval, 0.38-0.70), with consistent results in the per-protocol analysis (HR, 0.50; 95% confidence interval, 0.35-0.73). Survival benefit was evident up to about 80 years of age and among individuals with BMI ≥22 kg/m

conclusionsIn this target trial emulation study, SGLT2 inhibitors were associated with lower mortality in older adults with DKD, particularly those under 80 years and with BMI ≥22 kg/m

Indexed as

Diabetes Mellitus, Type 2Diabetic NephropathiesDipeptidyl-Peptidase IV InhibitorsSodium-Glucose Transporter 2 InhibitorsAgedAged, 80 and overFemaleHumansJapanMaleDipeptidyl-Peptidase IV InhibitorsSodium-Glucose Transporter 2 Inhibitors

Identifiers

PMID41574952
PMCPMC12992184

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.