How do GLP-1RAs and SGLT2is compare in treating T2D?

  • Hussein H & al.
  • Diabetes Obes Metab
  • 19 Feb 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • In a comparison of sodium-glucose cotransporter-2 inhibitors (SGLT2is) and long-acting glucagon-like peptide-1 receptor agonists (GLP-1RAs) in treating type 2 diabetes (T2D), each class shows greater benefit for specific outcomes.

Why this matters

  • Few head-to-head data are available for T2D treatments.

Study design

  • Systematic review/meta-analysis of 64 trials with 31,384 participants.
  • Funding: National Institute for Health Research, UK.

Key results

  • Steeper HbA1c reductions (95% credible interval; CrI) at 24 weeks with long-acting GLP-1RAs vs: 
    • SGLT2is: −0.28% (−0.47% to −0.10%); and
    • Short-acting GLP-1RAs: −0.46% (−0.67% to −0.25%).
  • Compared with other treatments vs placebo, the greatest HbA1c reduction was seen with long-acting GLP-1RA semaglutide at:
    • 24 weeks: −1.49% (−1.76% to −1.22%); and
    • 52 weeks: −1.38% (−2.05% to −0.71%).
  • Steeper BP reductions at 24 weeks with SGLT2is vs short-acting GLP-1RAs:
    • Systolic: −1.62 mmHg (−3.18 to −0.05). 
    • Diastolic: −1.32 mmHg (−2.05 to −0.65).
  • Steeper cholesterol reductions with long-acting GLP-1RAs vs SGLT2is:
    • Total: −0.24 mmol/L (−0.39 to −0.09).
    • High-density lipoprotein: −0.08 mmol/L (−0.15 to −0.01).
    • Low-density lipoprotein: −0.19 mmol/L (−0.31 to −0.07).
  • Genital infection odds were higher with SGLT2is:
    • OR, 5.26 (95% CrI: 1.45-25.00).
  • Diarrhea odds (ORs) were higher with: 
    • Short-acting GLP-1RAs: 1.65 (95% CrI: 1.09-2.49); and
    • Long-acting GLP-1RAs: 2.23 (95% CrI: 1.51-3.28).

Limitations

  • GLP-1RA formulation differences not analyzed.
  • Limited follow-up.