A large real-world study published in Clinical Kidney Journal found that the pattern of kidney disease in people with type 2 diabetes has shifted meaningfully over the past 15 years — with less protein in the urine but more cases of quietly declining kidney function. For the millions using GLP-1 medications to manage their diabetes or weight, the findings carry important implications for how kidney health should be monitored.
What the Study Found
Researchers analyzed clinical data from 378,914 people with type 2 diabetes seen through the AMD (Associazione Medici Diabetologi) network in Italy in 2023, then compared those results to a similar real-world cohort from roughly 15 years earlier in Italy.
The key finding: albuminuria — the presence of protein in the urine that has long been the classic early warning sign of diabetic kidney disease — is becoming less common. At the same time, the study identified a rise in a different pattern: isolated low eGFR, meaning reduced kidney filtration function without the accompanying protein leak.
This shift suggests the face of diabetic kidney disease is changing, likely influenced by evolving treatment regimens, including the broader use of medications that protect the kidneys.
Why This Matters for GLP-1 Users
GLP-1 receptor agonists like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) have demonstrated cardiovascular and metabolic benefits in large clinical trials, and research into their kidney-protective properties is ongoing. The AMD study specifically evaluated how different treatment regimens correlated with these shifting kidney disease phenotypes.
The practical concern for patients: if declining eGFR — not protein in the urine — is increasingly the dominant pattern, standard urine tests alone may miss early kidney problems. Someone on a GLP-1 medication might feel well and have a normal urine albumin result while their filtration rate is quietly declining.
Key takeaway: Kidney disease in type 2 diabetes is increasingly showing up as reduced filtration (low eGFR) rather than protein in the urine. If you have type 2 diabetes, make sure your monitoring includes both a urine albumin test and an eGFR blood test — not just one or the other.
What This Means for Your Care
The study's findings reinforce why comprehensive kidney monitoring matters for anyone managing type 2 diabetes, including those on GLP-1 therapies:
- Relying on urine protein tests alone could leave low eGFR cases undetected.
- Routine blood work that includes creatinine and eGFR calculation is essential.
- Treatment choices — including which diabetes medications you use — appear to correlate with these shifting disease patterns, according to the study's analysis.
What to Watch Next
This research adds to a growing body of evidence shaping how clinicians think about kidney protection in type 2 diabetes. Future studies are likely to dig deeper into which specific treatment regimens — including GLP-1 receptor agonists, SGLT2 inhibitors, and others — are driving the decline in albuminuria and whether the rise in isolated low eGFR requires new screening protocols. Patients currently on Ozempic, Wegovy, Mounjaro, or Zepbound should discuss their kidney monitoring plan with their prescriber, particularly if they have a long history of diabetes or other kidney risk factors.
Frequently Asked Questions
Kidney health is a critical part of long-term diabetes management, especially for those on GLP-1 therapies. Always speak with your prescriber or care team about the right monitoring schedule and what these evolving disease patterns mean for your individual situation.
- Peer-reviewed journal article, 'Evolving kidney disease phenotypes in type 2 diabetes: declining albuminuria and increasing isolated low eGFR,' Clinical Kidney Journal, 2024.