Cardiovascular, Kidney, and Safety Outcomes With GLP-1 Receptor Agonists Alone and in Combination With SGLT2 Inhibitors in Type 2 Diabetes: A Systematic Review and Meta-Analysis
Authors' conclusion
In people with type 2 diabetes, the cardiovascular and kidney benefits of GLP-1 receptor agonists are consistent regardless of SGLT2 inhibitor use.
Study context
- Population
- T2DM; subgroups with and without SGLT2 inhibitor at baseline
- Participants
- 17,072 participants3 trials
- Comparison
- GLP-1 receptor agonists vs placebo, by baseline SGLT2 inhibitor use
- Outcome
- MACE (nonfatal MI, stroke or CV death) and hospitalization for HF
Methodological detailsdouble-blind, placebo-controlled, supplemented by unpublished data, inverse variance-weighted
- Double-blind
- Placebo-controlled
- Supplemented by unpublished data
- Inverse variance-weighted
Pooled result
As reported in the abstract
MACE
GLP-1 receptor agonists vs PlaceboHazard ratio (95% CI)
Overall
0.79(0.71–0.87)
Receiving SGLT2 inhibitors
0.77(0.54–1.09)
Not receiving SGLT2 inhibitors
0.79(0.71–0.87)
Further pooled results
Hospitalisation for HF, by baseline SGLT2 inhibitor use
- HR with SGLT2 inhibitor at baseline
- 0.58 [95% CI, 0.36-0.93]
- HR without SGLT2 inhibitor at baseline
- 0.73 [95% CI, 0.63-0.85]
- P-heterogeneity=0.26
Composite kidney outcome (≥50% eGFR reduction, kidney failure or death from kidney failure)
- Risk ratio
- 0.79 [95% CI, 0.66-0.95]
- Did not vary by SGLT2 inhibitor use
- P for heterogeneity = 0.53
eGFR slope (annualised rate of eGFR decline)
- eGFR slope effect
- 0.78 mL/min/1.73 m²/y [95% CI, 0.57-0.98]
- Did not vary by SGLT2 inhibitor use
- P for heterogeneity = 0.94
Safety
Serious adverse effects and severe hypoglycemia
- Similar regardless of SGLT2 inhibitor use
- P-heterogeneity=0.29 and 0.50, respectively
Original publication
Cardiovascular, Kidney, and Safety Outcomes With GLP-1 Receptor Agonists Alone and in Combination With SGLT2 Inhibitors in Type 2 Diabetes: A Systematic Review and Meta-Analysis. Circulation. Published 30 August 2024. doi:10.
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