Why the study?
What is the optimal positioning and sequencing of SGLT2 inhibitors and GLP-1 receptor agonists in adults with CKD and T2D?
What is the optimal positioning and sequencing of SGLT2 inhibitors and GLP-1 receptor agonists in adults with CKD and T2D?
An international Delphi consensus recommends SGLT2 inhibitors as foundational therapy for adults with CKD and T2D, with GLP-1 RAs added for those with ongoing progression or high cardiometabolic risk.
Prioritizes SGLT2is as first-line in CKD with T2D; extends evidence by defining GLP-1 RA sequencing for progression or high risk.
INTRODUCTION: The optimal positioning and sequencing of sodium-glucose co-transporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in adults with chronic kidney disease (CKD) with type 2 diabetes (T2D) and overweight/obesity is unclear. This Delphi panel aimed to establish expert consensus on the foundational versus adjunctive role of SGLT2is and GLP-1 RAs in this adult population. METHODS: A total of 114 participants across 10 countries participated in a two-round Delphi panel (9.7% drop-off rate between rounds). Statement development was guided by a systematic literature review and 12 global experts. Consensus was pre-defined as ≥ 75% agreement/disagreement. The Delphi panel took place between 29 August and 20 October 2025. RESULTS: and cardiometabolic complications and comorbidities [e.g. residual glycated haemoglobin A1c (HbA1c) elevation, atherosclerotic cardiovascular disease]. Combination therapy was considered appropriate for adults with persistent kidney disease progression, high cardiovascular risk or suboptimal metabolic control. CONCLUSION: While treatment of adults with CKD and T2D should be holistic, SGLT2is should be prioritised as foundational therapy, independent of BMI, to reduce cardiorenal risk. Combination therapy with GLP-1 RAs was preferred for those with ongoing CKD progression and/or high cardiometabolic risk. Further clarity is required around the optimal timing of combination and sequential add-on therapy initiation.
No takes yet. Share an insight, caveat, or question.
Handelsman et al. (2026) studied Chronic Kidney Disease with Type 2 Diabetes (n=114). SGLT2 inhibitors and GLP-1 receptor agonists was evaluated on Consensus on Delphi statements (≥ 75% agreement/disagreement). An international Delphi panel reached consensus that SGLT2 inhibitors should be foundational therapy for adults with CKD and T2D independent of BMI, with GLP-1 RAs as add-on therapy.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: