The American Journal of Medicine · Mar 9, 2026

Glucagon-like peptide-1 receptor agonist and lupus nephritis in systemic lupus erythematosus with type 2 diabetes

By Hanif M, Nagarajan JS, Murphy R et al.

BACKGROUND: Systemic lupus erythematosus and type 2 diabetes mellitus are chronic inflammatory diseases that impact kidney function. Glucagon-like peptide-1 receptor agonist (GLP-1 RA), have shown benefits in several inflammatory diseases. However, their role in systemic lupus erythematosus, particularly in lupus nephritis, and disease flare are not well understood. We explored the hypothesized association between exposure to GLP-1 RA and renal and inflammatory outcomes in patients with systemic lupus erythematosus and type 2 diabetes mellitus. METHODS: This retrospective cohort study utilized a global database of electronic health records from approximately 141 million patients. After propensity score matching, the study included 9,386 systemic lupus erythematosus patients with type 2 diabetes mellitus, stratified by GLP-1 RA exposure. RESULTS: Among 9,386 systemic lupus erythematosus patients with type 2 diabetes mellitus, the average age in the GLP-1 RA-exposed group was 61.6 years. The relative risk of lupus nephritis was comparable (RR 0.57, 95% CI: 0.26-1.25, P = 0.15) at one-month follow-up; however, GLP-1 RA exposure was associated with a lower risk of lupus nephritis at one year (RR 0.59, 95% CI: 0.40-0.86, P < 0.01) compared to the control group. Secondary outcomes, including systemic lupus erythematosus flare, all-cause mortality, acute myocardial infarction, and hospitalization rate were observed less frequently in the GLP-1 RA group at one-year follow-up. The ischemic stroke risk was similar between the two groups at one month, however, GLP-1 RA exposure was associated with a lower risk of ischemic stroke at one year CONCLUSION: GLP-1 RA exposure in systemic lupus erythematosus patients with type 2 diabetes mellitus is associated with reduced risks of lupus nephritis, and systemic lupus erythematosus flares.

doi.org/10.1016/j.amjmed.2026.02.016Open accessPubMed 41812723Interventions