New Treatments for Diabetic Kidney Health

Both the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) have recently called attention to kidney and heart health, alongside continued glycemic control, in their most recent care guidelines. 

The 2022 Standards of Medical Care in Diabetes from the ADA make specific recommendations for using glucose-lowering medications that also impart heart or kidney health benefits, often earlier than previous treatment protocols. In this representation of its four pillars of diabetes care, as described in the latest ADA care guidelines, “agents with cardiovascular and kidney benefit” are listed on equal footing with glycemic, blood pressure, and lipid management.

 

New Classes of Medication Supporting Kidney Health in Diabetes

Two new classes of medication, SGLT-2 inhibitors and GLP-1 receptor agonists, have shown clinically-proven benefits for kidney health (along with lowering blood glucose levels) in people with type 2 diabetes. A third new class, non-steroidal MR antagonists, has received FDA approval for its kidney health benefits for people experiencing chronic kidney disease. While these new medications are now available in the US, many are just now learning about their benefits. 

Here’s a quick overview of each:

SGLT-2 Inhibitors

Delivered as a pill, SGLT-2 inhibitors lower blood glucose levels in people with diabetes by blocking glucose from being reabsorbed from the blood as it’s being filtered by the kidneys. 

They also provide some amount of protection to kidney function, slowing the progression of  chronic kidney disease (CKD) associated with diabetes (DKD). 

The first approval by the FDA for SGLT-2 inhibitor use by people with type 2 diabetes came in 2013. To date, Farxiga is the only SGLT-2 approved by the FDA specifically for its kidney protective properties. 

The kidney benefits of SGLT-2 inhibitors are not limited to type 2 diabetes. In fact, there are reports of doctors prescribing SGLT-2 inhibitors “off label” to people with type 1 diabetes as an add-on treatment. SGLT-2 inhibitors cannot replace insulin and they can increase the risk of diabetic ketoacidosis (DKA), so they should only be used by people with type 1 diabetes with a doctor’s supervision. 

Like all medications SGLT-2 inhibitors have potential side effects. One common side effect of SGLT-2 inhibitors is that people taking them urinate more often and can experience an increased risk of developing urinary tract infections (UTIs). 

SGLT-2 inhibitors are available in the US under several brand names.

These brands are currently approved by the FDA:

• Farxiga (dapaglifozin) 

• Invokana (canaglifozin) 

• Jardiance (empagliflozin) 

• Steglatro (ertugliflozin)

GLP-1 Receptor Agonists 

Delivered as an injectable or a pill, GLP-1 receptor agonists reduce blood glucose levels by releasing the gut hormone GLP-1. Found in the small intestine, GLP-1 both stimulates insulin secretion and inhibits glucagon secretion. It also slows the process of emptying the stomach, leaving the person with the feeling of fullness and extending the time it takes for glucose to be released from the food eaten. 

By improving glucose management, GLP-1 agonists also lower the risk of developing chronic kidney disease associated with diabetes (DKD). 

Victoza, an injectable, was the first GLP-1 agonist approved by the FDA in 2014. The latest GLP-1 agonist to receive FDA approval is Rybelsus, a pill approved in 2019. 

All of the FDA-cleared GLP-1 agonists are approved for use by people with type 2 diabetes to help manage blood glucose levels. They can be used alone or with other diabetes medications. However, when GLP-1 agonists are taken with other diabetes medications there is a higher risk of experiencing hypoglycemia. 

GLP-1 agonists are available in the US under several brand names. 

These brands have received FDA approval:

• Adlyxiin (lixisenatide) 

• Bydureon BCise (exenatide)

• Ozempic (semaglutide) 

• Rybelsus (oral semaglutide) 

• Trulicity (dulaglutide) 

• Victoza (liraglutide) 

Non-steroidal MR Antagonist: Finerenone

Finerenone blocks the receptors in the kidneys that retain salt and water. As a consequence the progression of chronic kidney disease is slowed, reducing the risk of decline in kidney function and, ultimately, kidney failure. Finerenone also provides some protection to the heart function, reducing the risk of heart attack. 

Finerenone was the first non-steroidal mineralocorticoid receptor (MR) antagonist for use by people with chronic kidney disease associated with type 2 diabetes (DKD). It received FDA approval in 2021.   

Potential side effects of finerenone include a mineral imbalance in the blood, affecting potassium and sodium in particular, and low blood pressure. 

There is currently one non-steroidal MR antagonist that has received FDA-approval, its brand name is Kerendia.  

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Innovation Continues in Diabetic Kidney Health

These new classes of medications represent just one of the many innovative approaches to preserving and improving kidney health for people with diabetes. Medical devices, like the continuous glucose monitor (CGM), are supporting kidney health by improving glucose management. And health screens, like NaviDKD, anticipate the likelihood of developing kidney complications. 

Stay tuned for even more exciting updates on advancements in kidney health as time progresses.