Glucagon-Like Peptide 1 Receptor Agonists and Sodium-Glucose Cotransporter 2 Inhibitors Improve Renal Resistive Index in Patients With Type 2 Diabetes: A 26-Week Prospective Observational Real-Life Study

Overview

Journal J Diabetes Res

Publisher Wiley

Specialty Endocrinology

Date 2025 Feb 18

PMID 39963363

Authors

Alfredo Vozza

Sara Volpe

Carlo Custodero

Valentina Colaianni

Valentina Lavarra

Domenico Triggiani

Lucilla Crudele

Alessandro Bergamasco

Gianfranco Antonica

Cosimo Tortorella

Giuseppina Piazzolla

Affiliations

Soon will be listed here.

Abstract

Diabetic kidney disease (DKD) is one of the most life-threatening complications of diabetes and a leading cause of chronic kidney disease. Glucagon-like peptide 1 receptor agonists (GLP1-RAs) or sodium-glucose cotransporter 2 inhibitors (SGLT2is) appear to improve renal outcome in patients with Type 2 diabetes (T2D). In this context, the renal resistive index (RRI) is a useful doppler measure to study DKD and predict its evolution. The aim of this work was to study the effect of treatment with GLP1-RA or SGLT2i on RRI and the relationship between RRI and glycometabolic parameters. One hundred forty-five patients with T2D were enrolled in the study and treated for 26 weeks with once-weekly GLP1-RA (38 patients with dulaglutide and 39 with semaglutide), SGLT2i (40 patients), or other therapies (28 control patients). Clinical, anthropometric, and hematochemical parameters and RRI were measured at baseline (T0) and after 6 months of treatment (T6). Changes at 6 months were studied and compared by treatment group. Patients were predominantly male (58.6%), overweight (93.0%) or frankly obese (60.0%), with hypertension (90.0%) and high (> 0.64) or pathological (> 0.7) RRI values (82.0% or 37.0%, respectively). At baseline, RRI correlated positively with age, fasting blood glucose, glycated hemoglobin (HbA1c), triglycerides, and albuminuria and negatively with estimated-glomerular filtration rate (e-GFR). At T6, patients treated with either GLP1-RA or SGLT2i showed a significant improvement in RRI but not in albuminuria or e-GFR, compared with homologous at baseline. In particular, RRI normalized in 32% and 30% of patients on therapy with GLP1-RA and SGLT2i, respectively, while remaining almost unchanged in controls. Notably, the RRI improvement was independent of age, gender, diabetes duration, and changes in BMI, waist circumference, HbA1c, and e-GFR. In conclusion, RRI can be used to detect early kidney damage and follow the evolution of DKD. GLP1-RA and SGLT2i improve RRI, demonstrating benefits on cardiovascular risk and renal outcomes.

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