What does this research mean for the field?

In patients with type 2 diabetes, GLP-1 receptor agonists are superior to SGLT-2 inhibitors in reducing all-cause mortality when eGFR >90 mL/min/1.73 m2, whereas SGLT-2 inhibitors are more effective at reducing renal outcomes and heart failure hospitalizations in patients with lower eGFRs. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 11, 2025Open Access

Comparison of the Effects of SGLT-2i versus GLP-1RA on Cardiovascular and Renal Outcomes in Patients with Type 2 Diabetes Mellitus based on Baseline Renal Function

Structured PICO

Does GLP-1RA compared to SGLT-2i improve cardiovascular and renal outcomes in patients with type 2 diabetes based on baseline renal function?

Population

87,334 patients with type 2 diabetes mellitus (T2D) from 10 RCTs, analyzed across different baseline glomerular filtration rates (eGFRs)

Intervention

Glucagon-like peptide 1 receptor agonists (GLP-1RA)

Comparator

Sodium-glucose cotransporter 2 inhibitors (SGLT-2i) (indirect comparison via network meta-analysis)

Outcome

Cardiovascular and renal outcomes (including all-cause death, renal outcome, and hospitalization for heart failure)hard clinical

The comparative efficacy of GLP-1RA versus SGLT-2i in type 2 diabetes varies by baseline renal function, with GLP-1RA favored for mortality in normal renal function but SGLT-2i favored for heart failure and renal outcomes in mild-to-moderate CKD.

Abstract

Finding no head-to-head research evaluating the cardiovascular and renal benefits of sodium-glucose cotransporter 2 inhibitors (SGLT-2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA) in patients with type 2 diabetes (T2D) at different baseline renal function, we performed a network meta-analysis to compare the two drugs indirectly. Systematic literature searches were conducted of the PubMed, Cochrane Library, Web of Science, and Embase databases, covering their inception until 7 January 2025. Randomized controlled trials (RCTs) comparing the effects of SGLT-2i and GLP-1RA in T2D with different glomerular filtration rates (eGFRs) were selected. Results were reported as risk ratios (RRs) with corresponding 95% CIs. Finally, 10 RCTs involving 87,334 patients with T2D were included. In patients with an eGFR >90 mL/min/1.73 m2, GLP-1RA exhibited a superior ability to reduce the risk of all-cause death compared with SGLT-2i (RR 0.75; 95% CI 0.58, 0.97), but it was less effective in reducing the risk of renal outcome (RR 1.80; 95% CI 1.15, 2.84) in patients with an eGFR 60-90 mL/min/1.73 m2. Conversely, in patients with eGFR 30-60 and 60-90 mL/min/1.73 m2, GLP-1RA did not show an advantage in reducing the risk of hospitalization for heart failure (RR 1.87 95% CI 1.15, 3.04 and 1.37 95% CI 1.05, 1.78, respectively).

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