Diabetic kidney disease is the most common cause of end stage renal disease in Australia. It is also strongly associated with increased overall mortality, cardiovascular mortality, cardio-vascular events. BP, lipid and glucose control remains the mainstay of our management for these patients.
SGLT2 inhibitors, works on the renal proximal tubules, suppress glucose reabsorption and increase urinary glucose excretion. Not only do they improve glycaemic control and effect modest weight loss, they have been shown to have reno-protective benefits.
Albuminuria is correlated with the progression of diabetic nephropathy, cardiovascular mortality, and all-cause mortality and reduction of albuminuria appears to equate to reno-protection. The effects of DPP4 inhibitors on diabetic nephropathy are less well-known. There are studies confirming the reno-protective effects of DPP-4i.
What about SGLT2i and DPP4i in combination? Will they be additive effects on reno-protection since the mechanisms of action of both classes of drugs are so different? Of course, the PBS would not allow us to prescribed them together. The DELIGHT trial is a randomised, double-blinded, placebo controlled, parallel design study to evaluate the efficacy, safety and pharmacodynamics or dapagliflozin and dapagliflozin in combination with saxagliptin in CKD patients with Type 2 diabetes mellitus and albuminuria treated with ACEi or ARB.
If you have patients with T2D whose
- HbA1c is >7.00%
- eGFR <80 and microalbuminuria and
- is not a DPP4i, SGLT2i or GLP1- injection
- is on an ACEi or ARB
- he/she may be suitable for the trial. Patients on insulin or sulphonyureas are sutable. Not only will their glycaemic control be better with the combination of medications, close follow up by the clinical trial personnel will improve compliance. Further, it is likely that their renal function will improve.
Our patients with T2D often miss out on clinical trials which doesn ‘t come to southwest Sydney often. If you a patient that has not reached their clinical targets, this will be a great opportunity.
If you have patients that fit the bill, contact Brunelle at B.Fernandes@westernsydney.edu.au