SGLT-2i significantly reduced the risk of atrial fibrillation in patients with Type 2 Diabetes compared to GLP-1RA (RR 0.86; 95% CI 0.79-0.95) and DPP-4i (RR 0.80; 95% CI 0.74-0.87).
Meta-Analysis (n=2,171,267)
Do SGLT-2 inhibitors reduce the risk of atrial fibrillation compared to GLP-1 receptor agonists and DPP-4 inhibitors in patients with Type 2 Diabetes Mellitus?
SGLT-2 inhibitors are associated with a significantly lower risk of atrial fibrillation and new-onset AF compared to GLP-1 receptor agonists and DPP-4 inhibitors in patients with Type 2 Diabetes Mellitus.
Relative Risk: 0.86 (95% CI 0.79–0.95)
OBJECTIVE: To evaluate the atrial fibrillation (AF) risk of sodium-glucose cotransporter-2 inhibitors (SGLT-2i), glucagonlike peptide-1 receptor agonists (GLP-1RA) and dipeptidyl peptidase-4 inhibitors (DPP-4i) in patients with Type 2 Diabetes Mellitus (T2DM) with network meta-analysis. METHODS: Systematic literature searches were conducted of MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Clinical Trials.gov covering inception till January 31, 2026. Randomized control trials (RCTs) and cohort studies comparing SGLT-2i, GLP-1RA and DPP-4i in diabetes were selected. We performed a network meta-analysis to compare the three drugs indirectly. Results were reported as risk ration (RR) with corresponding 95% confidence interval (CI). RESULTS: 4 RCTs and 21 cohort studies involving 2,171,267 patients were included. Compared with GLP-1RA RR with 95% CI: 0.86(0.79, 0.95), RR with 95% CI: 0.87(0.78, 0.97) and DPP-4iRR with 95% CI: 0.80(0.74, 0.87), RR with 95% CI: 0.81(0.74, 0.88), SGLT-2i significantly reduced the risk of AF and new-onset AF. While there were no significant difference in the risk of AF recurrence among SGLT-2i, GLP-1RA, and DPP-4iRR with 95% CI: 0.87(0.68, 1.12), RR with 95% CI: 0.80(0.61, 1.05), RR with 95% CI: 0.92(0.63, 1.33). There were also no significant difference in the risk of AF and new-onset AF between GLP-1RA and DPP-4iRR with 95% CI: 0.93(0.84, 1.03), RR with 95% CI: 0.93(0.83, 1.04). CONCLUSIONS: The management of T2DM involves the prevention of subsequent cardiovascular complications. The results of this network meta-analysis indicate that SGLT2i is associated with a lower risk of AF in T2DM patients compared to GLP-1RA and DPP-4i. Sensitivity analysis further confirms that SGLT-2i significantly reduces the risk of AF recurrence statistically. These finding suggests that SGLT-2i should be considered as a preferred antidiabetic regimen for patients with T2DM at high risk of AF.
Ye et al. (Wed,) conducted a meta-analysis in Type 2 Diabetes Mellitus (n=2,171,267). SGLT-2i vs. GLP-1RA and DPP-4i was evaluated on atrial fibrillation (AF) (RR 0.86, 95% CI 0.79-0.95). SGLT-2i significantly reduced the risk of atrial fibrillation in patients with Type 2 Diabetes compared to GLP-1RA (RR 0.86; 95% CI 0.79-0.95) and DPP-4i (RR 0.80; 95% CI 0.74-0.87).