Does Combination Therapy With a Glucagon-Like Peptide-1 Receptor Agonist and a Sodium-Glucose Cotransporter 2 Inhibitor Enhance Cardiovascular and Renal Protection in People With Type 2 Diabetes Mellitus?

The glucagon-like peptide-1 receptor agonist (GLP-1 RA) plus sodium-glucose cotransporter 2 inhibitor (SGLT2i) group shows a lower risk of major adverse cardiovascular events (MACE), admission due to heart failure (HF), and worsening chronic kidney disease (CKD), as determined by exploratory analysis; however, statistical superiority criteria were not met. The major cause of mortality in patients with diabetes is cardiovascular disease, and it is crucial to address this burden. This study evaluated the cardiovascular effects of combining glucagon-like peptide-1 receptor agonists (GLP-1 RAs) with sodium-glucose cotransporter 2 inhibitors (SGLT2is) versus either drug alone in patients with type 2 diabetes (T2D). This retrospective cohort study used data from 238 patients with a diagnosis of T2D aged 18 years or older who were followed for at least four years by the Endocrinology Department at Hospital Divino Espírito Santo, Ponta Delgada, Portugal. We included individuals who were treated for at least one year with a combination of GLP-1 RA and SGLT2i (n=99), compared with GLP-1 RA monotherapy (n=61) and SGLT2i monotherapy (n=78). The primary outcome was the reduction of major adverse cardiovascular events. The secondary outcomes were the reduction of worsening chronic kidney disease, the reduction of admissions due to heart failure, and the safety profile.