SGLT2is top GLP-1RAs for some patients with T2D

  • Circulation

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • In patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease (ASCVD), glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) reduce major adverse cardiovascular events (MACE) similarly. 
  • But SGLT2is hold the advantage in preventing hospitalization for heart failure (HF) and reducing estimated glomerular filtration rate (eGFR) in many patients.

Why this matters

  • Few data are available comparing outcomes for the 2 drug classes.

Study design

  • Systematic review, trial-level meta-analysis of 5 GLP-1RA and 3 SGLT2i cardiovascular outcome trials.
  • MACE: composite of myocardial infarction, stroke, cardiovascular death.
  • Funding: German Research Foundation, Harvard University/Brigham and Women's Hospital.

Key results

  • Risk reductions (HRs; 95% CIs) in MACE:
    • 12% for GLP-1RAs: 0.88 (0.84-0.94; P<.001 and>
    • 11% with SGLT2is: 0.89 (0.83-0.96; P=.001).
  • For patients with established ASCVD, MACE risk reduction (HRs; 95% CIs) was almost identical:
    • SGLT2i: 0.86 (0.80-0.93); and 
    • GLP-1RA: 0.87 (0.82-0.92).
  • HF hospitalization (HRs; 95% CIs):
    • Not reduced with GLP-1RAs: 0.93 (0.83-1.04; P=.20);
    • Reduced with SGLT2is: 0.69 (0.61-0.79; P<.001>
  • Composite kidney outcome (HRs; 95% CIs):
    • GLP-1RA reduced: 0.82 (0.75-0.89; P<.001>
    • Greater reduction with SGLT2is: 0.62 (0.58-0.67; P<.001>

Limitations

  • Patient-level data not included.
  • Inclusion/exclusion criteria differed across trials.  
  • No head-to-head comparisons or examination of combining classes.
  • Recent GLP-1RA trial not included.

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