SGLT2 Inhibitors

Adult CKD trials have confirmed cardiorenal protective effects of SGLT2 inhibitors. The DAPA-CKD trial demonstrated that dapagliflozin reduced kidney and cardiovascular events compared with placebo. Median follow-up in the SGLT2i cohort was 1.4 months, substantially shorter than the GLP-1 RA cohort's 2.3 months, driven by later drug launches in China. SGLT2i became broadly available in China after 2017, which directly explains the short follow-up durations and why most eligible patients had index dates outside the 2012–2019 study period. Clinical trial data indicate that proteinuria and renal protection effects are independent of concurrent RAAS inhibitor therapy. SGLT2 inhibitors reduce renal reabsorption of sodium and glucose. SGLT2 inhibitors may protect kidneys through mechanisms that do not depend on glucose lowering. SGLT2 inhibitors have shown good tolerability in children and adolescents aged at least 10 years with type 2 diabetes. The high ACS incidence rate in the SGLT2i cohort may be partly explained by diagnostic misclassification when multiple conditions are recorded within a single hospitalisation episode, introducing upward bias in event counts.