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Background <p>While the FLOW trial established the renoprotective effects of subcutaneous semaglutide, real-world evidence regarding the long-term renal effects of therapeutic switching from injectable glucagon-like peptide-1 receptor agonists (GLP-1RAs) to oral semaglutide remains limited. We evaluated long-term changes in renal function following this therapeutic switch.</p> Methods <p>This retrospective cohort study included 36 patients with type 2 diabetes (T2D) who were switched from liraglutide or dulaglutide to oral semaglutide (7&#xa0;mg/day). Changes in the urinary albumin-to-creatinine ratio (UACR) and annual estimated glomerular filtration rate (eGFR) slope were compared between the 3-year periods immediately before and after the switch.</p> Results <p>Three years after switching, the median UACR significantly decreased from 54.3 to 35.8&#xa0;mg/g creatinine (<i>p</i> &lt; 0.05). The annual eGFR slope improved from − 1.92 (95% CI − 2.66 to − 1.18) before switching to − 0.26 (95% CI − 1.01 to 0.50) mL/min/1.73 m<sup>2</sup>/year after switching (difference: 1.67; <i>p</i> &lt; 0.01). Subgroup analysis showed a significant improvement in eGFR slope among patients with baseline eGFR ≥ 60&#xa0;mL/min/1.73 m<sup>2</sup> (difference: 1.85; <i>p</i> &lt; 0.01). Reductions in glycated hemoglobin (− 0.33%, <i>p</i> &lt; 0.05) and body weight (− 3.50&#xa0;kg, <i>p</i> &lt; 0.01) were sustained at 3&#xa0;years. Improvement in eGFR slope was significantly associated with the magnitude of weight loss (<i>p</i> &lt; 0.05) and lower baseline HbA1c (<i>p</i> &lt; 0.01).</p> Conclusions <p>Therapeutic switching from injectable GLP-1RAs to oral semaglutide was associated with attenuation of renal function decline and reduction in albuminuria over 3&#xa0;years. These findings suggest potential long-term renal benefits of oral semaglutide in routine clinical practice.</p>

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Three-year changes in renal function after switching from injectable GLP-1 receptor agonists to oral semaglutide in Japanese patients with type 2 diabetes: a retrospective cohort study

  • 期刊论文

  • 发表日期：

    2026年4月30日

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  • Satoru Takashima,
  • Kanji Terui,
  • Fukuko Yamada,
  • Takashi Shimotomai

摘要

Background

While the FLOW trial established the renoprotective effects of subcutaneous semaglutide, real-world evidence regarding the long-term renal effects of therapeutic switching from injectable glucagon-like peptide-1 receptor agonists (GLP-1RAs) to oral semaglutide remains limited. We evaluated long-term changes in renal function following this therapeutic switch.

Methods

This retrospective cohort study included 36 patients with type 2 diabetes (T2D) who were switched from liraglutide or dulaglutide to oral semaglutide (7 mg/day). Changes in the urinary albumin-to-creatinine ratio (UACR) and annual estimated glomerular filtration rate (eGFR) slope were compared between the 3-year periods immediately before and after the switch.

Results

Three years after switching, the median UACR significantly decreased from 54.3 to 35.8 mg/g creatinine (p < 0.05). The annual eGFR slope improved from − 1.92 (95% CI − 2.66 to − 1.18) before switching to − 0.26 (95% CI − 1.01 to 0.50) mL/min/1.73 m2/year after switching (difference: 1.67; p < 0.01). Subgroup analysis showed a significant improvement in eGFR slope among patients with baseline eGFR ≥ 60 mL/min/1.73 m2 (difference: 1.85; p < 0.01). Reductions in glycated hemoglobin (− 0.33%, p < 0.05) and body weight (− 3.50 kg, p < 0.01) were sustained at 3 years. Improvement in eGFR slope was significantly associated with the magnitude of weight loss (p < 0.05) and lower baseline HbA1c (p < 0.01).

Conclusions

Therapeutic switching from injectable GLP-1RAs to oral semaglutide was associated with attenuation of renal function decline and reduction in albuminuria over 3 years. These findings suggest potential long-term renal benefits of oral semaglutide in routine clinical practice.