SGLT2 Inhibitors Show Promise in Reducing Cardiovascular and Renal Complications in Patients with SLE and Type 2 Diabetes

In a recent study published in Arthritis & Rheumatology, researchers explored the effects of sodium-glucose co-transporter 2 inhibitors (SGLT2i) on patients with systemic lupus erythematosus (SLE) and type 2 diabetes (T2D), two conditions that individually raise the risk of cardiovascular and renal complications. While SGLT2 inhibitors have shown significant benefits in reducing these complications in broader diabetic populations, their efficacy had not been assessed in SLE patients who have co-occurring T2D. This study, led by Dr. Karen H. Costenbader of Brigham and Women’s Hospital, used a population-based trial emulation to assess how SGLT2 inhibitors compared to dipeptidyl peptidase-4 inhibitors (DPP4i), a common diabetes treatment, in reducing adverse health outcomes in this unique patient group.

Key Findings: Reduced Risk of Renal and Heart Failure Events With SGLT2 Inhibitors

The study evaluated 2,165 SLE patients who initiated SGLT2 inhibitors and matched them with 2,165 patients starting DPP4 inhibitors. Over an average follow-up period of 753 days, researchers observed several advantages for the SGLT2i group. Notably, SGLT2i users had a 51% lower risk of acute kidney injury, a 39% lower risk of chronic kidney disease, and a 60% reduced risk of end-stage renal disease. Additionally, heart failure rates decreased by 28%, and emergency department visits were reduced by 10% compared to DPP4i users. These results underscore the potential of SGLT2 inhibitors as an effective treatment to reduce both renal and cardiovascular risks in this population with dual diagnoses.

Despite these promising findings, SGLT2i users did not see a significant reduction in other adverse events, such as all-cause mortality, lupus nephritis, myocardial infarction, or stroke, compared to those on DPP4 inhibitors. Furthermore, the study noted an increased risk of genital infections among SGLT2i users, though there was no heightened risk for urinary tract infections, diabetic ketoacidosis, or fractures.

Why This Matters: A New Avenue for Managing SLE and Diabetes Complications

Patients with SLE and T2D face compounded risks for cardiovascular and renal complications, leading to higher morbidity and mortality. Traditional diabetes treatments, while effective in general populations, have not been extensively studied in this subgroup, leaving a critical gap in care guidelines. By showing the distinct benefits of SGLT2 inhibitors in reducing kidney and heart failure risks, this study suggests a new therapeutic option for a vulnerable patient population that has long lacked targeted research. Additionally, the real-world approach of the study enhances its relevance, demonstrating that SGLT2 inhibitors could provide practical, effective risk reduction for SLE patients with T2D. These findings may inform future clinical guidelines and support more tailored treatment strategies for this complex patient group.

As SGLT2 inhibitors continue to gain attention for their cardiorenal benefits, this research provides crucial insights into their potential in managing high-risk conditions beyond typical diabetic populations.