Kidney Week

Abstract: TH-PO1057

Risk of Gastroparesis Is Higher with Glucagon-Like Peptide 1 Receptor Agonists (GLP-1 RAs) but Risk of Death Is Higher with Insulin Glargine in Veterans with Type 2 Diabetes and 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

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

Ravinder Singh, MS

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

Guo Wei, MS

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

Sydney Elizabeth Hartsell, MD, MPH

• 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

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

Srinivasan Beddhu, MD

Background

There is a paucity of data on the risk of gastroparesis risk with GLP1-RA compared to insulin glargine (IG) or SGLT2i in T2D with CKD.

Methods

We used the active comparator, new user design to emulate a trial to compare the effects of IG, GLP1-RA or SGLT2i in veterans with T2D on metformin without baseline GI comorbidities who initiated one of these three agents for the first time between 01/01/18 to 12/31/21. Administrative censor date was 03/31/23. Generalized propensity score based inverse probability weighting (IPW) was employed to control confounding and facilitate comparisons among the drug classes. In IPW Cox models, the study drug classes were related to the risk of gastroparesis and death in those without (N=119945) and with CKD (eGFR < 60, N=23027).

Results

In the CKD cohort, 36% were initiated on IG, 15% on GLP1-RA and 49% on SGLT2i. In IPW Cox regression, IG had a decreased risk of gastroparesis although had a higher risk of death when compared to GLP1-RA (Figures). IG was associated with increased risk of both outcomes when compared to SGLT2i. SGLT2i had a lower risk of gastroparesis and similar risk of death compared to GLP1-RA. Similar trend was seen in the non-CKD subgroup, although SGLT2i was had a higher risk of death compared to GLP1-RA.

Conclusion

As the risk of death with IG is higher, concern for gastroparesis should not prohibit prescription of GLP1-RA over IG in people with T2D and CKD.

Funding

• NIDDK Support