Evidence map›Paper›PMID 42109572›Full record

ArticleThe Lancet. Primary care2026

Kidney outcomes with GLP-1 receptor agonists in people with type 2 diabetes already receiving SGLT2 inhibitors: a target trial emulation study using UK primary care data.

Thijs T Jansz, Andrew P McGovern, Katherine G Young, Martha M Dinsdale, Pedro Cardoso, Beverley M Shields, Andrew T Hattersley, Angus G Jones, Ewan R Pearson, Coralie Bingham and 2 more

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Article in The Lancet. Primary care, 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. Review
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

12 authors.

Thijs T JanszUniversity of Exeter Medical School, University of Exeter, Exeter, UK.
Andrew P McGovernUniversity of Exeter Medical School, University of Exeter, Exeter, UK.
Katherine G YoungUniversity of Exeter Medical School, University of Exeter, Exeter, UK.
Martha M DinsdaleUniversity of Exeter Medical School, University of Exeter, Exeter, UK.
Pedro CardosoUniversity of Exeter Medical School, University of Exeter, Exeter, UK.
Beverley M ShieldsUniversity of Exeter Medical School, University of Exeter, Exeter, UK.
Andrew T HattersleyUniversity of Exeter Medical School, University of Exeter, Exeter, UK.
Angus G JonesUniversity of Exeter Medical School, University of Exeter, Exeter, UK.
Ewan R PearsonDivision of Diabetes, Endocrinology, and Reproductive Biology, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
Coralie BinghamUniversity of Exeter Medical School, University of Exeter, Exeter, UK.
Richard A OramUniversity of Exeter Medical School, University of Exeter, Exeter, UK.
John M DennisUniversity of Exeter Medical School, University of Exeter, Exeter, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Type 2 diabetes is the leading cause of kidney failure and is predominantly managed in primary care. Large randomised trials have shown that GLP-1 receptor agonists and SGLT2 inhibitors each slow kidney disease progression, but their combined effect on kidney outcomes remains unclear. We aimed to evaluate the comparative effectiveness of GLP-1 receptor agonists versus DPP-4 inhibitors or sulfonylureas on kidney outcomes in individuals with type 2 diabetes already receiving SGLT2 inhibitor treatment. Methods: In this observational study, we emulated a pragmatic target trial using an active-comparator, new-user cohort design with UK primary care electronic health record data (Clinical Practice Research Datalink, March 31, 2013-March 31, 2023) with linkage to hospital inpatient, deprivation, and mortality data. We included individuals with type 2 diabetes already receiving SGLT2 inhibitors who newly initiated either GLP-1 receptor agonists or comparator drugs DPP-4 inhibitors or sulfonylureas. We excluded those with estimated glomerular filtration rate (eGFR) of less than 20 mL/min per 1·73 m Findings: We included 33 659 treatment initiations (20 039 GLP-1 receptor agonists and 13 620 DPP-4 inhibitors or sulfonylureas; among 31 650 unique individuals), of whom these initiations occurred among 20 239 (60%) male individuals and 13 420 (40%) female individuals; median age was 60 years (IQR 53-67), and 26 530 (79%) were White, 4492 (13%) south Asian, 1398 (4%) Black, and 1239 (4%) of other ethnicities. Over a median follow-up of 1·4 years (IQR 0·6-3·0), kidney disease progression occurred in 187 (0·9%) of 20 039 individuals who initiated a GLP-1 receptor agonist and 189 (1·4%) of 13 620 who initiated a DPP-4 inhibitor or sulfonylurea. GLP-1 receptor agonist initiation was associated with a lower risk of kidney disease progression compared with DPP-4 inhibitor or sulfonylurea initiation (HR 0·73 [95% CI 0·58-0·92]). GLP-1 receptor agonist initiation was not associated with occurrence of acute pancreatitis (32 [0·2%] of 19 727 individuals with no recorded history of pancreatitis who initiated a GLP-1 receptor agonist Interpretation: These real-world data suggest that the kidney-protective benefits of GLP-1 receptor agonists observed in randomised trials of individuals with type 2 diabetes might also extend to individuals already receiving SGLT2 inhibitors. This finding supports consideration of combination treatment for kidney protection in primary care, particularly in individuals at highest absolute risk. Further prospective data would be valuable to confirm these findings. Funding: UK Medical Research Council.

Identifiers

PMID42109572
PMCPMC13153036

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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.