Abstract Background The implementation gap between evidence-based SGLT2 inhibitor therapy and real-world practice remains substantial in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Protocolized care delivery bundles incorporating frequent follow-up, systematic monitoring and adherence support may bridge this implementation gap. Objective To evaluate the impact of a a structured, nurse-delivered multi component pathway (frequent contact, protocolized monitoring, and adherence reminders) on kidney function progression and clinical outcomes in patients with T2DM and CKD. Methods This single-center, retrospective cohort study included 450 patients with T2DM and CKD who initiated SGLT2 inhibitors between February 2024 and February 2025. Patients were categorized into structured nurse-delivered multi component pathway management ( n = 225) or conventional care ( n = 225) groups. Primary outcomes included annualized eGFR decline rate and composite kidney endpoint (≥ 40% eGFR decline, end-stage kidney disease, or kidney-related death). Propensity score weighting was applied to balance baseline characteristics. Results The structured nurse-delivered multi component group demonstrated a slower annualized eGFR decline compared to conventional care. The composite kidney endpoint occurred less frequently in the structured nurse-delivered multi component group (HR 0.68, 95% CI 0.52–0.89, P = 0.004). Laboratory follow-up compliance was significantly higher in the structured nurse group (82.3% vs. 64.7%, P < 0.001). Adverse event-related drug discontinuation was lower with structured nurse-delivered multi component group (8.4% vs. 15.2%, P = 0.012). Conclusion A structured SGLT2 inhibitor management bundle delivered through a nurse-coordinated pathway reflecting greater care intensity and standardized follow-up was associated with improved kidney function trajectories and fewer adverse kidney outcomes in routine practice. Clinical trial number The clinical trial was registered in the Chinese Clinical Trial Registry (ChiNHSMU20231015).
Huang et al. (Sat,) studied this question.