Associations of finerenone with reduced insulin resistance in patients with type 2 diabetes and chronic kidney disease: A real‐world observational study

ABSTRACT Introduction There is evidence linking activation of aldosterone activity with insulin resistance and metabolic risk factors. We hypothesized that finerenone, a nonsteroidal mineralocorticoid receptor antagonist, might improve insulin resistance in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). Materials and Methods In a single‐center retrospective study including 45 patients with T2D and CKD treated with finerenone for 12 months between June 2023 and June 2025, we assessed insulin resistance using the Homeostasis Model Assessment of Insulin Resistance (HOMA‐IR) and triglyceride‐glucose (TYG) index along with metabolic and renal parameters measured at baseline, month‐6, and month‐12. Results In these patients ( n = 45; mean age 52.2 ± 13.9 years; 64.4% male; disease duration >10 years in 48.9%; mean HbA1c 9.2 ± 2.5%; 60.0% treated with SGLT2i; 33.3% on GLP1RA), 12‐month treatment with finerenone was associated with improvement in HOMA‐IR (median interquartile range: baseline: 34.40 12.84, 71.50, month‐6: 25.22 13.54, 78.19, month‐12: 19.44 9.51, 45.75 P = 0.038, Friedman test). TYG index (baseline: 9.49 8.86, 10.29 month‐6: 9.04 8.54, 9.71, and month‐12: 8.93 8.44, 9.62 mg/dL P < 0.007 Friedman tset ); urinary albumin: creatinine ratio (baseline: 377.39 127.80, 1327.29, month‐6: 342.96 87.58, 1442.12, month‐12: 249.52 68.04, 1198.03 mg/g p = 0.05, Friedman test ) and estimated glomerular filtration rate (baseline: 112.01 85.87, 120.00, month‐6: 103.92 75.25, 120.00, and month‐12120.00 80.46, 120.00 mL/min/1.73 m 2 P = 0.002 Feirdman test ). There was no treatment discontinuations due to hyperkalemia. Conclusion In real‐world practice, 12‐month treatment with finerenone was associated with reduced insulin resistance and improved kidney function in patients with T2D and CKD and a manageable safety profile.