Medications for Type 2 Diabetes and Chronic Kidney Disease

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Diabetes Drugs That Directly Benefit the Kidneys

The U.S. Food and Drug Administration (FDA) has approved two drug classes for managing type 2 diabetes that have direct and significant benefits on kidney health: sodium-glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists.

SGLT2 Inhibitors

SGLT2 inhibitors are daily pills that block your body’s ability to reabsorb sugar (glucose) from your blood, causing extra sugar to leave your body through urine.

These drugs were originally intended to help lower blood-sugar levels in people with type 2 diabetes. But long-term studies have also found that SGLT2 inhibitors offer significant kidney and heart health protection. Some of these studies were stopped early, because the evidence in favor of kidney benefits was so overwhelming that it became unethical to keep giving a placebo (a sham treatment) to volunteers with diabetes and CKD in the control group.

These trials have found that SGLT2 inhibitors can slow kidney-function decline by up to 60 percent, which significantly delays the development of severe outcomes like kidney failure and early death.

SGLT2 inhibitors can be prescribed to people at most stages of CKD, including those with advanced kidney failure or a high risk of kidney failure: “People with advanced CKD but who are not yet on dialysis can also benefit,” says Alexander Turchin, MD, director of quality in diabetes at Brigham and Women’s Hospital, and an associate professor at Harvard Medical School in Boston, Massachusetts.

It’s less clear whether or not SGLT2 inhibitors protect the kidney health of people who haven’t yet developed measurable kidney disease, as this hasn’t yet been tested rigorously. “But, based on what we know so far, it might be reasonably expected that there would be benefits to kidney health from their use,” says Dr. Turchin.

SGLT2 inhibitors on the market that are approved for the treatment or prevention of kidney disease include:

canagliflozin (Invokana)
dapagliflozin (Farxiga)
empagliflozin (Jardiance)

Common side effects include:

Dehydration
Urinating more often
Yeast infections and urinary tract infections (UTIs)
Low blood pressure
Low blood sugar

Along with their kidney benefits, SGLT2 inhibitors can help protect your heart and blood vessels by reducing blood pressure. That may reduce the risk of major heart events and hospitalizations for heart failure. SGLT2 inhibitors are generally safe for people with kidney issues, in whom many medications cause adverse effects.

GLP-1 Receptor Agonists

GLP-1 receptor agonists are best known as blockbuster diabetes and obesity medications. They mimic a hormone that triggers the release of insulin from your pancreas to support digestion and slow down your liver’s release of glucose to control blood sugar. They also increase how full you feel after meals and slow digestion.

GLP-1s can improve kidney health by keeping blood sugar levels within your target range and provoking weight loss. It’s also possible that they reduce inflammation in your kidneys or remove excess sodium from your body, but more research is needed to confirm the direct effects.

Though there are several GLP-1 drugs on the market, only one has been approved for the treatment of kidney disease in people with type 2 diabetes: semaglutide (Ozempic).

In a major trial, semaglutide significantly slowed the rate of kidney-function decline, reduced the risk of major kidney or cardiovascular events by 24 percent, and reduced the risk of death by 20 percent.

Early evidence suggests that tirzepatide (Mounjaro) also protects kidney function, but researchers have not yet completed the long and rigorous trials necessary to fully test the drug’s effect on kidney disease.

Though the evidence for kidney protection may be stronger for SGLT2 inhibitors than it is for GLP-1s, it’s not truly known if one drug is more effective than the other: “No one has compared them directly to each other, but SGLT2 inhibitors seem to be more effective in preventing [the] progression of kidney disease than GLP1s,” says Turchin.

And it’s possible to take them both at the same time, he says. “I wouldn’t usually think of it as a choice between the two. For all we know, combining both classes of medications may result in a greater benefit — although, again, testing hasn’t yet examined this. I usually recommend that my patients with kidney disease take both to prevent disease progression as much as possible.”

Semaglutide (Ozempic), the long-acting GLP-1 with FDA approval to treat type 2 diabetes and CKD, is available as a weekly injection. The most common side effects are gastrointestinal symptoms, including nausea, vomiting, and diarrhea. If you’re already using glucose-lowering medications such as insulin, you may need to change your dosage when starting semaglutide.

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