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The following is a summary of “Effects of SGLT2 inhibition on insulin use in CKD and type 2 diabetes: Insights from the CREDENCE trial,” published in the February 2025 issue of Nephrology Dialysis Transplantation by Beal et al. 

Insulin treats diabetes but causes weight gain and hypoglycemia. Data on SGLT2 inhibitors in CKD is limited. 

Researchers conducted a retrospective study on sodium-glucose cotransporter 2 (SGLT2) inhibitors in chronic kidney disease (CKD) and diabetes. Insulin use decreased with canagliflozin, reducing adverse effects while maintaining glycemic control. 

They conducted a post-hoc analysis of the CREDENCE trial, evaluating canagliflozin vs. placebo on insulin use in CKD and type 2 diabetes. They used Cox regression models to assess insulin initiation or >25% dose intensification. Effects on kidney, cardiovascular, and safety outcomes by baseline insulin use were also analyzed. 

The results showed that among 4,401 participants, 2,884 (65.5%) were on insulin at baseline, with lower eGFR, higher albuminuria, and longer diabetes duration (all P<0.001). Over a 2.0-year median, canagliflozin reduced insulin initiation or >25% dose intensification by 19% vs. placebo (HR 0.81, 95% CI 0.71-0.93), regardless of kidney function or albuminuria (both P-interaction>0.10). Canagliflozin led to >50% sustained insulin dose reductions more often than placebo (HR 1.49, 95% CI 1.15-1.91), with no difference in insulin discontinuation. Kidney, cardiovascular, and safety outcomes were consistent across baseline insulin use (all P-interaction>0.05). 

Investigators found that canagliflozin reduced insulin use in CKD and type 2 diabetes, with consistent effects regardless of kidney function. They supported its use for end-organ protection, improved glycemic control, and reduced insulin-related adverse effects. 

Source: academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfaf044/8046433