Survival benefits of glucose-lowering therapies across advanced kidney disease stages remain uncertain in type 2 diabetes mellitus (T2DM). In a retrospective observational study published in Diabetology, survival associations with GLP-1 RA use were evaluated across eGFR strata.

This administrative claims-based cohort included 1,188,052 U.S. Veterans with T2DM who were alive as of 1 January 2020. A total of 31,676 individuals met inclusion criteria and were followed through 31 December 2023. Initiation of GLP-1 RA therapy was treated as a time-dependent exposure, and all-cause mortality was assessed.

During follow-up, 6.1% of participants initiated GLP-1 RA therapy, and 57.7% died. Older age and eGFR < 15 mL/min/1.73 m² were associated with lower likelihood of GLP-1 RA initiation. Younger age and lower comorbidity burden were associated with reduced mortality after adjustment for baseline covariates.

GLP-1 RA initiation was associated with longer survival among participants with eGFR < 25 mL/min/1.73 m². This association remained significant with progressively lower kidney function and among those receiving KRT. No survival association was observed among participants with eGFR ≤ 15 mL/min/1.73 m².

These findings indicate that GLP-1 RA use was associated with improved survival across advanced stages of kidney dysfunction in T2DM, except at the lowest eGFR threshold.