Trial reportNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association2025
Effects of SGLT2 inhibition on insulin use in CKD and type 2 diabetes: insights from the CREDENCE trial.
Trial report in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2025. The graph read 2 numbers from its abstract, feeding 1 cell of the map, but none could be read as for or against, so it casts no vote. Cited by 2 papers.
What it found
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Sustained insulin dose reductions of >50% were achieved more frequently with canagliflozin than placebo [HR 1.49 (95% CI 1.15-1.91)], although no difference in insulin discontinuation was observed between treatment arms.
Over a median on-treatment period of 2.0 years, canagliflozin reduced the need for insulin initiation or a >25% dose intensification by 19% compared with placebo {hazard ratio [HR] 0.81 [95% confidence interval (CI) 0.71-0.93]}, irrespective of baseline kidney function or albuminuria (both P-interaction > .10).
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Where it lands on the map
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What it adds to each cell
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SGLT2 inhibitors×glycemic control
No readable resultOpen on the map →What to test next →40 readable studies in this cell: 81 favour the treatment, 11 find no difference, 4 favour the comparator.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed.
- Implementing SGLT2 Inhibitor Therapy in Line with the New NICE Guidelines for Type 2 Diabetes Management.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2026Review
- Advances regarding the mechanism of endoplasmic reticulum stress in diabetic kidney disease and pharmacological interventions (Review).Molecular medicine reports · 2026Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors.
Funding
Abstract
The marked sentences are the ones the graph read a number from.
backgroundInsulin is a mainstay treatment for diabetes, but its use is associated with weight gain and hypoglycaemia. Data on the effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors on insulin use in people with chronic kidney disease (CKD) are limited.
methodsWe conducted a post hoc analysis of the Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation trial. Effects of canagliflozin versus placebo on insulin use (initiation, dose intensification, reduction and discontinuation) in people with CKD and type 2 diabetes were evaluated using Cox regression models. The primary outcome was insulin initiation or a >25% insulin dose intensification (in those not receiving and receiving insulin at baseline, respectively). Effects on kidney, cardiovascular and safety outcomes by baseline insulin use were also assessed.
resultsAmong 4401 participants, 2884 (65.5%) were receiving insulin at baseline; these participants were more likely to have lower estimated glomerular filtration rate, higher albuminuria and a longer duration of diabetes (all P < .001). Over a median on-treatment period of 2.0 years, canagliflozin reduced the need for insulin initiation or a >25% dose intensification by 19% compared with placebo {hazard ratio [HR] 0.81 [95% confidence interval (CI) 0.71-0.93]}, irrespective of baseline kidney function or albuminuria (both P-interaction > .10). Sustained insulin dose reductions of >50% were achieved more frequently with canagliflozin than placebo [HR 1.49 (95% CI 1.15-1.91)], although no difference in insulin discontinuation was observed between treatment arms. Effects of canagliflozin on kidney, cardiovascular and safety outcomes were consistent regardless of baseline insulin use (all P-interaction > .05).
conclusionsIn CKD and type 2 diabetes, canagliflozin reduces insulin use with consistent effects regardless of baseline kidney function. This supports the use of canagliflozin in people with CKD, not only for end-organ protection, but also to improve glycaemic control and reduce exposure to insulin and its associated adverse effects.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.