SGLT2 inibitors comparison with GLP1 agonists - cardiovascular and renal benefits

Last edited 01/2021 and last reviewed 07/2021

A study has evaluated sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists in patients with type 2 diabetes at varying cardiovascular and renal risk (1).

A network analysis was undertaken involving:

  • randomised controlled trials comparing SGLT-2 inhibitors or GLP-1 receptor agonists with placebo, standard care, or other glucose lowering treatment in adults with type 2 diabetes with follow up of 24 weeks or longer
  • 764 trials including 421346 patients proved eligible. All results refer to the addition of SGLT-2 inhibitors and GLP-1 receptor agonists to existing diabetes treatment
    • both classes of drugs lowered all cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and kidney failure (high certainty evidence)
    • differences noted by the study authors included:
      • SGLT-2 inhibitors reduced mortality and admission to hospital for heart failure more than GLP-1 receptor agonists
      • GLP-1 receptor agonists reduced non-fatal stroke more than SGLT-2 inhibitors (which appeared to have no effect)
      • SGLT-2 inhibitors caused genital infection (high certainty),
      • GLP-1 receptor agonists might cause severe gastrointestinal events (low certainty)
      • SGLT-2 inhibitors and GLP-1 receptor agonists might lower body weight (low certainty for both)
      • absolute benefits of these drugs vary substantially across patients from low to very high risk of cardiovascular and renal outcomes (eg, SGLT-2 inhibitors resulted in 5 to 48 fewer deaths in 1000 patients over five years)

    • study authors concluded that patients with type 2 diabetes, SGLT-2 inhibitors and GLP-1 receptor agonists reduced cardiovascular and renal outcomes, with notable differences in benefits and harms. Absolute benefits are determined by individual risk profiles of patients


  • Palmer SC et al. Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials. BMJ 2021;372:m4573