Background The reno-protective effect of second-line treatments in type 2 diabetes has been assessed by clinical trials but generalizability to routine clinical practice is still uncertain. We aimed to assess the effectiveness of these treatments, when added to metformin, on the risk of chronic kidney disease (CKD). Methods A real-world, hospital-based, type 2 diabetes cohort was retrospectively assembled at Ramathibodi Hospital from 2010 to 2019. Patients who received sulfonylureas (SU), thiazolidinediones (TZD), dipeptidyl peptidase-4 inhibitors (DPP4i), or sodium-glucose cotransporter-2 inhibitors (SGLT2i), as second-line antihyperglycemic treatment were included. Treatment effect models with inverse probability weighting and regression adjustment were used to estimate CKD risk according to treatment. Results CKD was identified in 4,132 of the 24,777 patients with type 2 diabetes (16.7%). The CKD incidence (95% CI) was 4.1% (2.2%, 6.9%), 13.5% (12.5%, 14.6%), 14.8% (13.5%, 16.1%), and 18.0% (17.4%, 18.5%) for patients receiving SGLT2i, DPP4i, TZD, and SU treatment, respectively. The average treatment effects (i.e., the difference in CKD risk) for SGLT2i, DPP4i, and TZD compared to SU were − 0.142 (− 0.167, − 0.116), − 0.046 (− 0.059, − 0.034), and − 0.004 (− 0.023, 0.014), respectively, indicating a significant reduction in CKD risk of 14.2% and 4.6% in the SGLT2i and DPP4i groups, respectively, compared to the SU group. Furthermore, SGLT2i significantly reduced CKD risk by 13.7% (10.6%, 16.8%) and 9.5% (6.8%, 12.2%) when compared to TZD and DPP4i, respectively. Conclusions Our study identified 14.2%, 13.7%, and 9.5% reduced CKD risk in Thai patients with type 2 diabetes who were treated with SGLT2i compared to those treated with SU, TZD, and DPP4i, respectively, in real-world clinical data. Previous evidence of a reno-protective effect of SGLT2i reported in other populations is consistent with our observations in this Southeast Asian cohort.

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BACKGROUND Type 2 diabetes (T2D) is a major non-communicable disease that can progress to multiple complications that lead to significant burden at both individual and population levels. Understanding disease progression and transition between complication states will inform appropriate treatment and management strategy planning. This T2D cohort was ascertained to estimate the transition probabilities of diabetic complications. OBJECTIVE The aim of this study is to construct the T2D cohort profile and estimate the transition probabilities. METHODS This T2D cohort was based on routine clinical practice data collected from Ramathibodi Hospital, Bangkok, Thailand from 2010 to 2019. Adults with newly diagnosed T2D were considered eligible for inclusion if they were followed up on at least two occasions. Outcomes of interest included diabetic retinopathy (DR), chronic kidney disease (CKD), cardiovascular disease (CVD), peripheral vascular disease (PVD) and mortality. These data were identified from multiple sources and combined with laboratory and medication prescribing data. Ten-year transition probabilities were calculated by Kaplan-Meier estimates. RESULTS Of 40,662 incident T2D cases, the incidence rate/100 patients/year (95% confidence intervals [CI]) for CKD, CVD, DR, PVD and death were 3.3 (3.1-3.3), 2.7 (2.6-2.8), 1.6 (1.5-1.63), 0.50 (0.49-0.56), and 0.58 (0.54-0.62), respectively. The transition probabilities from a baseline complication-free T2D state to these corresponding states at 10 years were 0.26 (0.21-0.33), 0.19 (0.15-0.23), 0.13 (0.11-0.15), 0.03 (0.03-0.04), and 0.03 (0.02-0.04), respectively. CONCLUSIONS This well-characterized T2D cohort based on 10-year clinical practice data identified CKD as the most likely T2D complication, followed by CVD and DR. Further studies that consider prognostic factors, treatment safety and effectiveness, and economic evaluation will further guide treatment management and planning strategies in the Thai population.

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