Sydney Elizabeth Hartsell
· Assistant ProfessorVerifiedUniversity of Utah · Nephrology
Active 2013–2026
About
Sydney Elizabeth Hartsell, MD, MPH, is an Assistant Professor in the Department of Internal Medicine at the University of Utah. Her clinical practice is primarily based at the Kidney & Liver Clinic in Salt Lake City and the South Jordan Nephrology Clinic, where she specializes in nephrology and hypertension. She is board certified by the American Board of Internal Medicine with a subspecialty in Nephrology, reflecting her expertise in kidney-related health issues. Her educational background includes an interdisciplinary undergraduate major in Social Anthropology & Population Health with a minor in Chemistry & Music from the University of North Carolina at Chapel Hill. She earned her M.D. from the University of North Carolina School of Medicine and her MPH from the Gillings School of Global Public Health. Her postgraduate training includes internal medicine internship, residency, and fellowship at the University of Utah School of Medicine, where she also conducted nephrology research and served as a chief fellow. Dr. Hartsell's research focuses on various aspects of nephrology and hypertension, with publications addressing topics such as blood pressure management, metabolic acidosis, and kidney disease outcomes. She has contributed to multiple peer-reviewed journal articles, including meta-analyses and studies on cardiovascular outcomes, diabetes management, and kidney health. Her work emphasizes improving health through innovation and evidence-based practice in nephrology, and she is actively involved in academic research and teaching within her department.
Research topics
- Internal medicine
- Medicine
- Cardiology
- Intensive care medicine
- Emergency medicine
- Pediatrics
- Nursing
- Medical emergency
Selected publications
Primary care diabetes · 2026-04-10
articleOpen accessIn this pilot study, we identified rural veterans with chronic kidney disease and type 2 diabetes who have an indication for SGLT2i or GLP-1 RA but not yet on either of these agents. Nearly a third of providers changed their practice based on automatic e-consult; however, there were still 69% of cases where providers did not.
Journal of the American Society of Nephrology · 2026-01-13 · 1 citations
articleOpen access1st authorCorrespondingKEY POINTS: In veterans with type 2 diabetes and low kidney failure risk, sodium-glucose cotransporter 2 inhibitors (SGLT2is) were more kidney protective while glucagon-like peptide-1 receptor agonists (GLP-1 RAs) were more cardioprotective. For cardiovascular-kidney-metabolic outcomes, GLP-1 RAs were more protective at moderate kidney failure risk and SGLT2is were more protective at high kidney failure risk. The kidney failure risk equation might be a clinically useful tool to guide therapy in type 2 diabetes. BACKGROUND: Head-to-head comparisons of non-exendin glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) on kidney failure or cardiovascular-kidney-metabolic (CKM) composite end points are lacking. Whether kidney failure risk modifies the comparative effectiveness of GLP-1 RA versus SGLT2i is clinically relevant. METHODS: We defined a national veterans cohort with type 2 diabetes who initiated an SGLT2i, non-exendin GLP-1 RA, or insulin glargine between January 1, 2018, and December 31, 2021. After applying inverse probability of treatment weighting to balance baseline characteristics, outcomes were compared across new-user groups through March 31, 2023. Outcomes included kidney failure (stage 5 CKD or long-term KRT), major adverse cardiovascular events (MACEs: heart failure, myocardial infarction, or stroke), CKM composite (kidney failure or MACE), all-cause death, and composites of outcomes with death. We tested for effect modification by the kidney failure risk equation (KFRE) score on comparative pairwise drug effectiveness. RESULTS: Out of 160,428 veterans, 53%, 14%, and 34% were new users of SGLT2i, GLP-1 RA, and insulin glargine, respectively. Relative to GLP-1 RA new-users, SGLT2i new-users had similar mortality risk, a trend toward lower kidney failure risk (hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.74 to 1.06), but higher risk of MACE (HR, 1.14; 95% CI, 1.09 to 1.20) and CKM composite (HR, 1.13; 95% CI, 1.08 to 1.19). The effect of SGLT2i versus GLP-1 RA differed significantly between moderate-risk (2%-6%) and high-risk (≥6%) KFRE subgroups for all outcomes except all-cause death. In those with moderate-risk KFRE, GLP-1 RA seemed more protective for kidney failure, MACE, and CKM composite, while SGLT2i appeared more protective in those with high-risk KFRE. CONCLUSIONS: Compared with GLP-1 RA, SGLT2i had comparable risks of mortality, perhaps a lower risk of kidney failure, but modestly higher risk of cardiovascular events in the entire cohort. However, GLP-1 RA were more beneficial in those with moderate kidney failure risk and SGLT2i more beneficial in those with high kidney failure risk.
Diabetes Therapy With SGLT2i After Heart Transplant
JACC Heart Failure · 2025-06-25 · 4 citations
articleLiraglutide vs Semaglutide vs Dulaglutide in Veterans With Type 2 Diabetes
JAMA Network Open · 2025-10-13 · 5 citations
articleOpen accessImportance: The head-to-head comparative effectiveness and safety of individual glucagon-like peptide-1 receptor agonists (GLP-1RAs) are not well understood. Objective: To compare risks of kidney, cardiovascular, and death outcomes among patients with type 2 diabetes initiating GLP-1RAs in the Department of Veterans Affairs (VA) health system. Design, Setting, and Participants: This comparative effectiveness study used an active-comparator, new-user target trial-emulation design with national data linked among the VA, Medicare, and US Renal Data System. Participants were GLP-1RA-naive veterans with type 2 diabetes and without end-stage kidney disease treated with metformin who started liraglutide, semaglutide, or dulaglutide between January 1, 2018, and December 31, 2021. Data were analyzed from September 2024 to June 2025. Exposure: Liraglutide, semaglutide, or dulaglutide. Main Outcomes and Measures: Kidney failure (sustained estimated glomerular filtration rate <15 mL/min/1.73 m2 or initiation of kidney replacement therapy), composite cardiovascular and kidney metabolic (CKM) events (kidney failure or major adverse cardiovascular events [MACE]; myocardial infarction, heart failure, or stroke/transient ischemic attack), MACE, all-cause death, and adverse gastrointestinal events (gastroparesis, intestinal obstruction, gallstones, acute cholecystitis, acute pancreatitis) were evaluated separately through March 31, 2023. Results: Of 21 790 included veterans (mean [SD] age, 63.5 [10.8] years, 19 823 [91.0%] male), 5425 (24.9%), 10 838 (49.7%), and 5527 (24.9%) initiated liraglutide, semaglutide, and dulaglutide, respectively. In weighted Cox regression models, compared with initiation of semaglutide, liraglutide initiation had similar hazards for kidney failure (hazard ratio [HR], 0.93; 95% CI, 0.60-1.44), the CKM composite outcome (HR, 0.96; 95% CI, 0.84-1.10), and MACE (HR, 0.95; 95% CI, 0.83-1.09). Results were similar with liraglutide vs dulaglutide and dulaglutide vs semaglutide comparisons. Liraglutide had significantly lower hazard of all-cause death compared with semaglutide under intent-to-treat analyses (HR, 0.83; 95% CI, 0.69-0.99), which lost significance in per-protocol models. Compared with dulaglutide, liraglutide was associated with a lower risk of all-cause mortality in both the intent-to-treat (HR, 0.69; 95% CI, 0.58-0.83) and per-protocol (HR, 0.50; 95% CI, 0.31-0.82) analyses, but compared with semaglutide, dulaglutide had higher hazard of mortality only in the per-protocol model (HR, 1.72; 95% CI, 1.20-2.47). The only observed difference for the gastrointestinal adverse events was a decreased risk for gallstones and acute cholecystitis with dulaglutide vs semaglutide (gallstones: HR, 0.72; 95% CI, 0.54-0.95; acute cholecystitis: HR, 0.62; 95% CI, 0.39-0.99). Conclusions and Relevance: In this comparative effectiveness study in veterans with diabetes, liraglutide, semaglutide, and dulaglutide initiators had similar risks for kidney and cardiovascular outcomes. Head-to-head randomized trials are needed to confirm these findings.
Diabetes Obesity and Metabolism · 2025-01-30 · 2 citations
articleOpen accessAIMS: To compare the risk of all-cause death and cardiovascular events in new users of insulin glargine, glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i), particularly in subgroups defined by baseline haemoglobin A1C (HbA1C), body mass index (BMI) and estimated glomerular filtration rate (eGFR). MATERIALS AND METHODS: We conducted an active comparator, new user design study in a national cohort of 161 405 veterans with type 2 diabetes (T2D) on metformin and initiated insulin glargine (n = 54 375), GLP-1RA (n = 22 145) or SGLT2i (n = 84 885) between 1 January 2018 and 31 December 2021. Patients were followed until 31 March 2023. Inverse probability weighted Cox regression models were used for treatment comparisons on all-cause deaths and cardiovascular events in the entire cohort and above subgroups. RESULTS: There were 20 788 cardiovascular events/414 414 person-years and 15 268 all-cause deaths/446 458 person-years. Insulin glargine had a higher hazard of all-cause death compared to GLP-1RA (hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.48-1.67) or SGLT2i (HR 1.55, 95% CI 1.48-1.61) in the entire cohort and across subgroups, especially in those with HbA1C levels <9.0%. Results were similar for secondary outcomes. Compared to GLP-1RA, SGLT2i had similar risk of all-cause death (HR 1.03, 95% CI 0.97-1.10) but higher hazard of cardiovascular events (HR 1.13, 95% CI 1.08-1.19). Across subgroups, GLP-1RA and SGLT2i had generally similar effects, with SGLT2i showing a slightly higher risk in some cases. CONCLUSIONS: Insulin glargine might be deleterious particularly in those with HbA1C <9.0%. There was no clear evidence for prioritization of SGLT2i versus GLP-1RA across subgroups.
Journal of the American Society of Nephrology · 2025-10-01
article1st authorCorrespondingGlycemic therapies and the risk of gastrointestinal adverse events in veterans with type 2 diabetes
Diabetes Obesity and Metabolism · 2025-07-30 · 5 citations
articleOpen accessAIMS: To compare the risk of gastrointestinal adverse events in new users of glucagon-like peptide-1 receptor agonists (GLP-1RA), sodium-glucose cotransporter-2 inhibitors (SGLT2i) and insulin glargine. MATERIALS AND METHODS: We conducted an active comparator, new user design study in veterans with type 2 diabetes who initiated one of these drug classes between 1 January 2018 and 31 December 2021 (N = 141 080). Inverse probability weighted Cox regression models were used to relate drug class to outcomes of gastroparesis, intestinal obstruction, gallstones, acute cholecystitis, acute pancreatitis and all-cause death. RESULTS: There were 19 765 (14.0%) veterans initiated on GLP-1RA, 75 058 (53.2%) on SGLT2i and 46 257 (32.8%) on insulin glargine. Compared to SGLT2i, GLP-1RA had a higher hazard of gastroparesis (HR 1.65, 95% CI 1.33-2.05) but a similar mortality hazard. Compared to insulin glargine, GLP-1RA had a higher hazard of gastroparesis (HR 1.24, 95% CI 1.02, 1.52), but a lower hazard of all-cause death (HR 0.62, 95% CI 0.58, 0.66). Compared to SGLT2i, insulin glargine had a higher hazard of gastroparesis (HR 1.29, 95% CI 1.07, 1.56), intestinal obstruction (HR 1.26, 95% CI 1.11, 1.43) and all-cause death (HR 1.58, 95% CI 1.50, 1.65). Risks of gallstones, acute cholecystitis and pancreatitis were similar across the classes. CONCLUSIONS: In patients with type 2 diabetes at risk for gastroparesis, SGLT2i might be the preferred agent. In patients for whom SGLT2i is not an option or another agent is needed, patients and providers might need to weigh the higher risk of death with insulin glargine against the higher risk of gastroparesis with GLP-1RA.
Impact of SGLT2 Inhibitors and GLP-1 Receptor Agonists on Kidney Failure Risk Prediction
Journal of the American Society of Nephrology · 2025-10-01
article1st authorCorresponding2025-07-07
peer-reviewAlzheimer s & Dementia · 2025-12-01
articleOpen accessBACKGROUND: Liraglutide, semaglutide and dulaglutide are non-exendin based GLP-1RA that are widely used in type 2 diabetes (T2D) management. GLP-1RA use may be associated with lower risk of dementia, however, intra-class effects of GLP-1RA on AD/ADRD risk need to be further elucidated. METHOD: We followed the active comparator, new user design to emulate a trial comparing the effect of initiating liraglutide, semaglutide or dulaglutide. Veterans with T2D on metformin who initiated any one of these three agents between 01/01/2018 to 12/31/2021 and did not have baseline dementia, as identified by ICD 9 or 10 codes, were included (N = 21,173). Previous use of GLP-1RA, SGLT2i or insulin glargine was an exclusion criterion. Administrative censor date was 03/31/2023. Generalized propensity score based inverse probability weighting (IPW) was employed to control confounding in the observational data and facilitate comparisons among the three agents. In IPW Cox models with adjustment for baseline covariates, the study drug classes were related to the risk of AD/ADRD, death and composite of AD/ADRD/death. RESULT: Of the 21,173 veterans, 25% were initiated on liraglutide, 50% on semaglutide, and 25% on dulaglutide. The mean age was 63 ± 11 years, with 9% female and 17% African American. There were 679 AD/ADRD events over 62,724 person-years of follow up and 1,428 deaths over 63,579 person-years of follow-up. Semaglutide had the highest unweighted event rate of AD/ADRD compared to liraglutide and dulaglutide. In IPW Cox regression models, liraglutide had a lower risk of AD/ADRD compared to semaglutide (HR 0.68, 95% CI 0.55, 0.83), and similar risk compared to dulaglutide (Table). Semaglutide had a higher risk of AD/ADRD than dulaglutide (HR 1.32, 95% CI 1.08, 1.62). In addition, liraglutide had the lowest risk of death as well as composite AD/ADRD/death compared to both semaglutide and dulaglutide. CONCLUSION: Liraglutide had a lower risk of AD/ADRD compared to semaglutide as well as a lower risk of death compared to other commonly used GLP-1RA. Dulaglutide had similar risk of AD/ADRD to liraglutide, however death benefit was not seen.
Frequent coauthors
- 107 shared
Srinivasan Beddhu
VA Salt Lake City Healthcare System
- 91 shared
Amara Sarwal
University of Utah
- 89 shared
Robert E. Boucher
University of Utah
- 65 shared
Ravinder Singh
Health Sciences North
- 45 shared
McKenna Nevers
VA Salt Lake City Healthcare System
- 43 shared
Jincheng Shen
- 33 shared
Guo Wei
University of Utah
- 31 shared
Niharika Katkam
University of Utah
Labs
University of Utah Kidney & Liver Clinic and South Jordan Nephrology ClinicPI
Education
M.D.
University of Utah
Other
University of Utah
Other
University of North Carolina at Chapel Hill
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