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Data Items Collected The following variables were charted for each included source of evidence: Bibliographic information: author, year, country, funding Study characteristics: design, phase, sample size, duration, setting Population: diabetes type, overweight/obesity definitions, CKD stage, albuminuria status, baseline eGFR, concomitant therapies Intervention(s) or exposure: GLP-1 receptor agonist or tirzepatide (dose, route, duration) Comparator(s): placebo or active comparator Outcomes: kidney and cardiorenal measures (eGFR slope, composite renal endpoints, albuminuria, safety) Main findings: direction and magnitude of renal effect Appraisal and evidence rating: methodological quality, certainty, and relevance Notes: contextual remarks, analytic subgroups, and comments on applicability Appraisal and Evidence Rating Because this review was conducted to inform the RAND/UCLA Appropriateness Method for SLANH, each included study underwent a structured critical appraisal using the appropriate validated tool for its design: Randomized controlled trials: Cochrane Risk of Bias 2 (RoB 2) [10] Post hoc or secondary RCT analyses: adapted Cochrane or NIH tool Observational comparative studies: ROBINS-I [11] The AI tool was programmed to assist in pre-classifying bias domains (e.g., randomization, blinding, confounding) and to highlight textual evidence for reviewer judgment

Incidence of diabetic retinopathy did not differ between the orforglipron and placebo groups, and no hepatic safety signals were observed in the trial

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