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World J Diabetes. Nov 15, 2026; 17(11): 123922
Published online Nov 15, 2026. doi: 10.4239/wjd.123922
Published online Nov 15, 2026. doi: 10.4239/wjd.123922
Higher diversity of anti-diabetic therapy is associated with lower risk of major adverse kidney events in diabetes
Shu-Ping Zhang, Ting-Ting Huang, Qing-Lian Zeng, Wen-Jin Luo, Yun-Jie Xiong, Chuan Peng, Fei Lian, Qing-Feng Cheng, Zhi-Hong Wang, Qi-Fu Li, Shu-Min Yang, Xiang-Jun Chen, Jin-Bo Hu, Department of Endocrinology, Sichuan-Chongqing Joint Key Laboratory of Metabolic Vascular Diseases, Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Shu-Ping Zhang, Department of Endocrinology, Yichang Central People’s Hospital, The First College of Clinical Medical Science, China Three Gorges University, Yichang 443000, Hubei Province, China
Wei Huang, Yong Xu, Department of Endocrinology and Metabolism, Metabolic Vascular Disease Key Laboratory of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
Xi-Yue Li, Department of Nephrology, Metabolism and Immunology Laboratory for Urological Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Co-first authors: Shu-Ping Zhang and Ting-Ting Huang.
Co-corresponding authors: Jin-Bo Hu and Xi-Yue Li.
Author contributions: Zhang SP and Huang TT contributed equally to this article, they are the co-first authors of this manuscript; Zhang SP, Huang TT, Zeng QL, Luo WJ, and Xiong YJ performed the research and analyzed the data; Zhang SP, Huang TT and Chen XJ wrote the original draft; Peng C, Huang W, Yang SM, Chen XJ, and Hu JB designed the research study; Luo WJ, Lian F, and Chen XJ collected and curated the data; Xiong YJ validated the data; Cheng QF and Wang ZH provided research resources; Cheng QF, Wang ZH, Xu Y, Li QF, and Hu JB were responsible for project administration; Xu Y prepared the figures; Peng C, Li QF, Yang SM, and Chen XJ reviewed and edited the manuscript; Hu JB supervised the study; Li XY validated the data and revised the manuscript; Hu JB and Li XY contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors have read and approved the final manuscript.
AI contribution statement: AI tools, specifically Doubao AI Assistant (ByteDance), were used solely for language polishing and formatting assistance. No AI tool was used to generate research data, interpret results, or formulate conclusions. All AI-assisted content was critically reviewed and revised by the authors, who take full responsibility for the accuracy, originality, and integrity of the manuscript.
Supported by National Natural Science Foundation of China, No. 82671106 and No. 82501003; National Science and Technology Major Project, No. 2024ZD0523305; Chongqing Outstanding Youth Science Fund Project, No. CSTB2023NSCQ-JQX0028; Science and Technology Research Project of Chongqing Education Commission, No. KJQN202200403 and No. KJQN202500485; The 74th Batch of General Funding from the China Postdoctoral Science Foundation, No. 2023M740442; 2023 State-Funded Postdoctoral Researcher Program of China Postdoctoral Science Foundation, No. GZC20233341.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the First Affiliated Hospital of Chongqing Medical University, approval No. 2018-042.
Clinical trial registration statement: This study is registered at ClinicalTrials.gov (https://clinicaltrials.gov). The registration identification number is NCT03692884.
Informed consent statement: All study participants, or their legal guardians, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The datasets generated and/or analyzed during the current study are not publicly available but are available from the corresponding author (lixiyue@hospital.cqmu.edu.cn) on reasonable request.
Corresponding author: Xi-Yue Li, MD, PhD, Department of Nephrology, Metabolism and Immunology Laboratory for Urological Diseases, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi St, Chongqing 400016, China. lixiyue@hospital.cqmu.edu.cn
Received: June 2, 2026
Revised: July 21, 2026
Accepted: October 8, 2026
Published online: November 15, 2026
Processing time: 157 Days and 2.8 Hours
Revised: July 21, 2026
Accepted: October 8, 2026
Published online: November 15, 2026
Processing time: 157 Days and 2.8 Hours
Core Tip
Core Tip: Greater diversity of anti-diabetic therapy improves glycemic control, while its impact on kidney outcomes remains controversial. In two propensity-matched cohorts, combination therapy was associated with a 35%-76% lower major adverse kidney events risk vs monotherapy, independent of glycemic control and renoprotective medications. These findings support a potential association between greater diversity of anti-diabetic therapy and lower major adverse kidney events risk in patients with diabetes.