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논문분류	춘계학술대회 초록집
제목	Second-Line Antidiabetic Medications and Risk of Diabetic Kidney Disease in New-Onset Type 2 Diabetes
저자	Hyung Woo Kim
출판정보	2026; 2026(1):
키워드	Diabetic kidney disease, antidiabetic medication, chronic kidney disease
초록	Objectives: Sulfonylureas, dipeptidyl peptidase-4 (DPP-4) inhibitors, and thiazolidinediones remain widely used as cost-effective second-line medications. However, comparative evidence of their impact on diabetic kidney disease (DKD) versus sodium-glucose cotransporter-2 (SGLT2) inhibitors in patients with early-stage type 2 diabetes mellitus (T2DM) and preserved kidney function is limited. Methods: This target trial emulation used Korean National Health Insurance Service data and included adults aged 40–70 years with newly diagnosed T2DM who initiated metformin plus a second-line antidiabetic medication and had baseline eGFR ≥60 mL/min/1.73 m² without albuminuria. The primary outcome was incident diabetic kidney disease (DKD), defined as development of eGFR <60 mL/min/1.73 m² or albuminuria. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using overlap-weighted Cox models. Secondary outcomes included individual DKD components and longitudinal changes in eGFR. Results: Among the 101,136 participants, 6,090 incident DKD events occurred during a mean follow-up of 2.37 years. Compared with SGLT2 inhibitors, DPP-4 inhibitors (HR: 1.42; 95% CI: 1.22–1.64) and sulfonylureas (HR: 1.67; 95% CI: 1.40–1.98) were associated with higher DKD risk; while thiazolidinediones showed similar overall DKD and albuminuria risk but higher risk of eGFR decline. Conclusion: In early T2DM with preserved kidney function, SGLT2 inhibitors were associated with a lower risk of incident DKD compared with DPP-4 inhibitors and sulfonylureas. Thiazolidinediones showed comparable protection against albuminuria to SGLT2 inhibitors, despite a higher risk of eGFR decline. These findings support the consideration of kidney outcomes when selecting second-line antidiabetic therapies for early T2DM.
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