SGLT2i vs GLP-1RA: which to choose for T2D treatment?

  • McKee A & al.
  • J Endocr Soc
  • 1 May 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Reduced major adverse cardiovascular events (MACE) and cardiovascular (CV) deaths plus renal benefit are similar between glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is).
  • Adverse events are common with both.

Why this matters

Study design

  • Meta-analysis of major placebo-controlled cardiovascular outcomes trials, including 6 of GLP-1RAs (n=51,762) and 4 of SGLT2is (n=33,457).
  • Funding: None.

Key results

  • MACE decreased (all relative rates) with: 
    • GLP-1RAs: 0.91 (P<.001>
    • SGLT2is: 0.83 (P<.001>
    • No difference between classes: 1.09 (P=not significant).
  • Cardiovascular death decreased with:
    • GLP-1RAs: 0.88 (P=.002). 
    • SGLT2is: 0.85 (P=.001).
    • No difference between classes: 1.04 (P=not significant).
  • Heart failure hospitalization rates:
    • Improved with SGLT2is: 0.68 (P<.001>
    • Not improved with GLP-1RAs: 0.93 (P=not significant). 
    • Classes differed significantly: 1.38 (P<.01>
  • Major renal events decreased with:
    • GLP-1RAs: 0.83 (P<.001>
    • SGLT2is: 0.67 (P<.001>
    • No difference between them: 1.24 (P=not significant).
  • With SGLT2is, increased risks for:
    • Genital mycotic infections in women: 4.07 (P<.0001>
    • Diabetic ketoacidosis: 2.60 (P<.001>
  • GLP-1RAs were associated with:
    • Gastrointestinal adverse events: 2.65 (P<.01>
    • Gallstones (specifically liraglutide): 1.24 (P<.05>

Limitations

  • Secondary data.
  • Study durations, renal endpoints varied.
  • Limited to patients with estimated CV risk >10%.