- 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
- International guidelines recommend agents for type 2 diabetes (T2D) that confer cardiovascular and renal benefit.
- 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.
- 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).
- GLP-1RAs: 0.88 (P=.002).
- SGLT2is: 0.85 (P=.001).
- No difference between classes: 1.04 (P=not significant).
- Improved with SGLT2is: 0.68 (P<.001>
- Not improved with GLP-1RAs: 0.93 (P=not significant).
- Classes differed significantly: 1.38 (P<.01>
- GLP-1RAs: 0.83 (P<.001>
- SGLT2is: 0.67 (P<.001>
- No difference between them: 1.24 (P=not significant).
- Genital mycotic infections in women: 4.07 (P<.0001>
- Diabetic ketoacidosis: 2.60 (P<.001>
- Gastrointestinal adverse events: 2.65 (P<.01>
- Gallstones (specifically liraglutide): 1.24 (P<.05>
- Secondary data.
- Study durations, renal endpoints varied.
- Limited to patients with estimated CV risk >10%.