Kidney Week

Abstract: TH-PO1055

Insulin Glargine Compared with Glucagon-Like Peptide 1 Receptor Agonists (GLP-1 RAs) or SGLT2 Inhibitors Is Associated with Higher Risk of Alzheimer Disease and Alzheimer Disease-Related Dementias (AD/ADRD) in CKD

Session Information

• CKD: Therapeutic Advances
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Sarwal, Amara, University of Utah Health, Salt Lake City, Utah, United States

Amara Sarwal, MD

• Wei, Guo, University of Utah Health, Salt Lake City, Utah, United States

Guo Wei, MS

• Singh, Ravinder, University of Utah Health, Salt Lake City, Utah, United States

Ravinder Singh, MS

• Hartsell, Sydney Elizabeth, University of Utah Health, Salt Lake City, Utah, United States

Sydney Elizabeth Hartsell, MD, MPH

• Bress, Adam, University of Utah Health, Salt Lake City, Utah, United States

Adam Bress, PharmD

• Derington, Catherine G., University of Utah Health, Salt Lake City, Utah, United States

Catherine G. Derington, PharmD, MS

• Boucher, Robert E., University of Utah Health, Salt Lake City, Utah, United States

Robert E. Boucher

• Nevers, Mckenna R., University of Utah Health, Salt Lake City, Utah, United States

Mckenna R. Nevers, MSc

• Katkam, Niharika, University of Utah Health, Salt Lake City, Utah, United States

Niharika Katkam, MSc

• Takyi, Augustine, University of Utah Health, Salt Lake City, Utah, United States

Augustine Takyi

• Chakravartula, Akhil Ramanujam, University of Utah Health, Salt Lake City, Utah, United States

Akhil Ramanujam Chakravartula, MD, MBBS

• Shen, Jincheng, University of Utah Health, Salt Lake City, Utah, United States

Jincheng Shen, MS, PhD

• Greene, Tom, University of Utah Health, Salt Lake City, Utah, United States

Tom Greene, PhD

• Beddhu, Srinivasan, University of Utah Health, Salt Lake City, Utah, United States

Srinivasan Beddhu, MD

Background

It is unknown whether the risk of AD/ADRD is related to the use of insulin glargine (IG), GLP1-RA or SGLT2i in persons with T2D and CKD.

Methods

Using VA Informatics and Computing Infrastructure (VINCI) platform, we conducted an active comparator, new user design study to compare the effects of initiating IG, GLP1-RA, or SGLT2i on AD/ADRD between 1/1/18 to 12/31/21 in veterans with T2D on metformin and without AD/ADRD at baseline (N= 155,481). Prescriptions for these agents anytime between 1/1/08 to 1/1/18 was an exclusion. Follow-up was until 3/31/2023. Generalized propensity score based inverse probability weighting (IPW) was employed to control confounding in the observational data and facilitate comparisons among the three drug classes. In IPW Cox models, drug classes were related to time to the first diagnosis of AD/ADRD (defined by ICD-10) in those without and with CKD (eGFR <60).

Results

33.2% were initiated on IG, 12.8% on GLP1-RA and 53.0% on SGLT2i. 16% had CKD. There were 2970 AD/ADRD events over 361410 patient-years in non-CKD and 3946 AD/ADRD events over 64806 patient-years in CKD patients. In IPW Cox regression, IG had higher risk of AD/ADRD when compared to GLP1-RA and SGLT2i (Figures).

Conclusion

In both non-CKD and CKD subgroups, IG is associated with higher AD/ADRD risk when compared to SGLT2i and GLP1-RA whereas SGLT2i and GLP1-RA had similar risk.

Funding

• NIDDK Support