Impact of a structured nurse-delivered multi component SGLT2 inhibitor initiation and optimization pathway on kidney function and clinical outcomes in type 2 diabetes and chronic kidney disease: a real-world retrospective study

Abstract Background The implementation gap between evidence-based SGLT2 inhibitor therapy and real-world practice remains substantial in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Protocolized care delivery bundles incorporating frequent follow-up, systematic monitoring and adherence support may bridge this implementation gap. Objective To evaluate the impact of a a structured, nurse-delivered multi component pathway (frequent contact, protocolized monitoring, and adherence reminders) on kidney function progression and clinical outcomes in patients with T2DM and CKD. Methods This single-center, retrospective cohort study included 450 patients with T2DM and CKD who initiated SGLT2 inhibitors between February 2024 and February 2025. Patients were categorized into structured nurse-delivered multi component pathway management (n = 225) or conventional care (n = 225) groups. Primary outcomes included annualized eGFR decline rate and composite kidney endpoint (≥ 40% eGFR decline, end-stage kidney disease, or kidney-related death). Propensity score weighting was applied to balance baseline characteristics. Results The structured nurse-delivered multi component group demonstrated a slower annualized eGFR decline compared to conventional care. The composite kidney endpoint occurred less frequently in the structured nurse-delivered multi component group (HR 0.68, 95% CI 0.52–0.89, P = 0.004). Laboratory follow-up compliance was significantly higher in the structured nurse group (82.3% vs. 64.7%, P < 0.001). Adverse event-related drug discontinuation was lower with structured nurse-delivered multi component group (8.4% vs. 15.2%, P = 0.012). Conclusion A structured SGLT2 inhibitor management bundle delivered through a nurse-coordinated pathway reflecting greater care intensity and standardized follow-up was associated with improved kidney function trajectories and fewer adverse kidney outcomes in routine practice. Clinical trial number The clinical trial was registered in the Chinese Clinical Trial Registry (ChiNHSMU20231015).