EvidenceAlerts

Yuan D, Sharma H, Krishnan A, et al. Effect of glucagon-like peptide 1 receptor agonists on albuminuria in adult patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Diabetes Obes Metab. 2022 May 19. doi: 10.1111/dom.14776. (Systematic review)
Abstract

AIMS: To determine the effect of glucagon-like peptide 1 receptor agonists (GLP-1RAs) on albuminuria in adult patients with type 2 diabetes mellitus (T2DM).

METHODS: Medline Ovid, Scopus, Web of Science, EMCARE and CINAHL databases from database inception until 27 January 2022. Studies were eligible for inclusion if they were randomized controlled trials that involved treatment with a GLP-1RA in adult patients with T2DM and assessed the effect on albuminuria in each treatment arm. Data extraction was conducted independently by three individual reviewers. The PRISMA guidelines were followed regarding data extraction and quality assessment. Data were pooled using a random effects inverse variance model and all analysis was carried out with RevMan 5.4 software. The Jadad scoring tool was employed to assess the quality of evidence and risk of bias in the randomized controlled trials.

RESULTS: The initial search revealed 2419 articles, of which 19 were included in this study. An additional three articles were identified from hand-searching references of included reviews. Therefore, in total, 22 articles comprising 39 714 patients were included. Meta-analysis suggested that use of GLP1-RAs was associated with a reduction in albuminuria in patients with T2DM (weighted mean difference -16.14%, 95% CI -18.42 to -13.86%; p < .0001) compared with controls.

CONCLUSIONS: This meta-analysis indicates that GLP-1RAs are associated with a significant reduction in albuminuria in adult patients with T2DM when compared with placebo.

Ratings
Discipline Area Score
Family Medicine (FM)/General Practice (GP) 6 / 7
General Internal Medicine-Primary Care(US) 6 / 7
Endocrine 6 / 7
Internal Medicine 5 / 7
Comments from MORE raters

Endocrine rater

The real issue in this analysis is that most studies are of short duration and while reduction in albuminuria may be a surrogate for slowing impaired GFR, this has not been universally demonstrated with GLP-1 receptor agonists. Interesting but nothing clinically new nor requiring important dissemination.

Endocrine rater

Microalbuminuria in patients with T2DM is common. Microalbuminuria gradually progresses to macroalbuminuria and reduction of eGFR. Earlier introduction of GLP-1 agonists may reduce rapid progression to later stages of CKD. This meta-analysis should have a positive impact on T2DM patients with high risk for CKD.
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