Treatment outcomes and safety profile of SGLT2 inhibitors versus GLP-1 agonists in type 2 diabetes mellitus

Several pharmacotherapies are available to treat type 2 diabetes mellitus (T2DM) among which sodium–glucose cotransporter 2 inhibitors (SGLT2is) and glucagon-like peptide 1 (GLP-1) receptor agonists are significant. The current systematic review aims to critically evaluate various clinical outcomes and safety profile of SGLT2is in comparison to GLP‑1 receptor agonists for the management of T2DM utilizing real-world clinical data.

A total of 22,100 research articles were extracted from several electronic databases including EMBASE, PubMed, Clinicaltrials.gov, and Cochrane Library from January 2010 to September 2024. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to maintain consistency and transparency in research. To obtain insights from the real-world clinical data, observational studies were used for this review, excluding , randomized controlled trials.

The pooled analysis showed that risk ratio (RR) of heart failure and MACE (major cardiovascular events) or revascularization, and odds ratio (OR) of renal outcomes were slightly higher among SGLT2is (experimental) as compared to GLP‑1 agonist (control). In addition, the pooled analysis of hypoglycemic events and all-cause mortalities favored SGLT2is as compared to GLP‑1 agonist.

SGLT2is appear to be more effective in lowering hospitalization for heart failure; GLP‑1 medication appears to be safer and more successful in treating MACE and improving renal outcomes. Occurrence of hypoglycemic events and the rate of all-cause mortality were found to be low in the SGLT2is group, which supported the clinical implication of SGLT2is.