8 meta-analysis results to guide diabetes drug choice

Study clarifies the effects of SGLT2 inhibitors and GLP1 agonists on cardiovascular and renal outcomes

A meta-analysis has compared SGLT2 inhibitors and GLP1 receptor agonists for their effects on cardiovascular and renal outcomes in people with type 2 diabetes.

choosing drugs

Each drug class has been shown to improve cardiovascular and renal outcomes.

As they lower HbA1c by similar amounts, the decision on which class to choose may depend on the patient’s comorbidities and risk, according to the Harvard University authors, some of whom declare financial links to drug companies.

Their meta-analysis examines five GLP1 trials and three SGLT2 trials — including more than 77,000 patients — to quantify the effects of the drug classes on cardiovascular and renal outcomes.

Depending on the trial, median follow-up was between 1.6 and 4.2 years.

Here’s what the meta-analysis showed:

  1. In patients with established atherosclerotic cardiovascular disease, both GLP1s and SGLT2s reduce a composite measure (MACE — major adverse cardiac events — which includes myocardial infarction, stroke and death from CVD) by 14% compared with placebo.
  2. In people who have multiple risk factors for atherosclerosis, but do not actually have disease, neither drug class reduces the risk of MACE over short term follow-up of 2-4 years.
  3. Looking at the components of MACE individually, both GLP1s and SGLT2s reduce the risk of myocardial infarction and cardiovascular death.
  4. SGLT2 inhibitors reduce hospitalisation for heart failure by 31% compared with placebo. No such effect is seen for GLP1s.
  5. GLP1s reduce the risk of stroke by 14% compared with placebo. No such effect is seen for SGLT2s.
  6. Both classes reduce the risk of progression of renal disease (GLP1s by 18%, SGLT2s by 38% compared with placebo)
  7. GLP1s primarily reduce progression of renal disease by reducing macroalbuminuria.
  8. SGLT2s reduce the risk of worsening estimated glomerular filtration rate (eFGR), end-stage kidney disease and renal death by 45%.     

More information: Circulation 2019