Type 2 Diabetes Therapy Improves Cardiovascular and Kidney Outcomes

Semaglutide, a glucagon-like peptide 1 (GLP-1) receptor agonist designed to treat type 2 diabetes, is also effective at improving cardiovascular and kidney health and reducing the risk for death in people with type 2 diabetes and kidney disease.

As reported in the New England Journal of Medicine, the patients randomized to receive semaglutide versus placebo had a 24% lower risk of experiencing one or a combination of kidney failure, a significant reduction in kidney function (as measured by estimated glomerular filtration rate, eGFR), or death from kidney or cardiovascular related causes.

Other aspects of health were also improved in patients given the treatment. The cardiovascular event rate was 18% lower, all-cause deaths went down by 20%, and the rate of eGFR deterioration was also slowed.

Injectable semaglutide, which was developed by Danish pharma company Novo Nordisk, first achieved FDA approval for treatment of type 2 diabetes in 2017. Over the following few years, the company also achieved approval for an oral version of the drug, also to treat type 2 diabetes, and in 2021 a higher-dose version of injectable semaglutide was approved for treatment of obesity.

Although the benefits of GLP-1 receptor agonists on blood glucose and obesity have been known for some time, other health benefits of these therapies have only come to light more recently. For example, a study published in late 2023 showed that semaglutide has cardiovascular benefits as well as weight loss benefits in obese individuals without type 2 diabetes.

The current NEJM study, as well as another recent study in obese individuals, now show semaglutide can also have positive effects on kidney health.

The FLOW (Evaluate Renal Function with Semaglutide Once Weekly) study included 3533 patients with type 2 diabetes and chronic kidney disease, 1767 of whom were randomized to receive injected semaglutide and 1766 to receive placebo. The follow up period in the trial was a median of 3.4 years.

The primary outcome of the study was the impact of the treatment on major kidney disease events, including kidney failure, a significant loss of kidney function (eGFR reduction of 50% or more), or death from kidney- or cardiovascular-related causes.

Secondary trial outcomes included the effect on the annual rate of change in eGFR from randomization to the end of the trial; incidence of major cardiovascular events (nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes); and death from any cause.

Semaglutide was superior to placebo for all outcomes and less serious adverse events occurred in the treatment group than the placebo group.

“The use of GLP-1 receptor agonists in broader populations with type 2 diabetes has previously been shown to improve glycemic control, decrease body weight, and reduce cardiovascular events. However, previous dedicated trials addressing clinically important kidney outcomes, such as kidney failure or a substantial decline in the eGFR, have been lacking,” wrote first author Vlado Perkovic, a researcher at the University of New South Wales in Sydney, and colleagues.

“The magnitude of the benefits observed in our trial provides confidence that the use of semaglutide in patients with type 2 diabetes and chronic kidney disease will reduce the risk of kidney failure and slow the decline in the eGFR, as well as reduce the risk of cardiovascular events and death.”