Risk–Benefit Trade-offs of GLP-1RAs and SGLT-2is in Type 2 Diabetes Mellitus (T2D): Systematic Review, Meta-Analysis, and Net Benefit Modeling.
Introduction: While glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is) are established for cardiorenal benefits in type 2 diabetes mellitus (T2DM), prior meta-analyses have not fully integrated cross-class comparisons or net benefit analyses...
| Publicado en: | Diabetes Therapy Vol. 17; no. 1; pp. 55 - 73 |
|---|---|
| Autores principales: | , |
| Formato: | research systematic review tables/charts Journal Article |
| Publicado: |
Springer Nature
Jan2026
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=191132676&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 191132676 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 18696953 B7U9 jtl: Diabetes Therapy issn: 18696953 maglogo: N pubinfo: dt: Jan2026 vid: 17 iid: 1 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 191132676 189129772 191132676 191132676 10.1007/s13300-025-01817-5 191132676 ppf: 55 ppct: 18 formats: tig: atl: Risk–Benefit Trade-offs of GLP-1RAs and SGLT-2is in Type 2 Diabetes Mellitus (T2D): Systematic Review, Meta-Analysis, and Net Benefit Modeling. aug: au: Ghosal, Samit Ghosal, Anuradha affil: https://ror.org/05r0sm904 Nightingale Hospital, 11 Shakespeare Sarani, 700071, Kolkata, West Bengal, India sug: subj: Glucagon-Like Peptide-1 Receptor Agonists Therapeutic Use Sodium-Glucose Co-Transporter 2 Inhibitors Therapeutic Use Diabetes Mellitus, Type 2 Drug Therapy Treatment Outcomes Risk Assessment Cardiovascular Risk Factors Patient Safety Human Systematic Review Meta Analysis Confidence Intervals Sensitivity and Specificity Major Adverse Cardiac Events Heart Failure Hospitalization Retinal Diseases Amputation ab: Introduction: While glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is) are established for cardiorenal benefits in type 2 diabetes mellitus (T2DM), prior meta-analyses have not fully integrated cross-class comparisons or net benefit analyses with updated cardiovascular outcome trials (CVOTs). Methods: We conducted a systematic review and meta-analysis of 17 CVOTs (N = 132,038; GLP-1RA: N = 73,263; SGLT-2i: N = 58,775) using PubMed and Cochrane CENTRAL. We uniquely synthesized major adverse cardiovascular events (MACE), hospitalization for heart failure (hHF), renal composites, and safety outcomes (e.g., retinopathy, genitourinary infections) with random-effects models for hazard ratios (HRs) and relative risks (RRs). Innovative graphical syntheses (tornado/scatter plots, risk curves) and net benefit calculations (absolute risk reductions [ARRs] minus absolute excess risks [AERs]) were employed. Risk of bias (RoB 2) and GRADE certainty were assessed. Results: Both classes reduced MACE (HR 0.87, 95% CI 0.84–0.90; p = 0.73 for class difference). SGLT-2is were superior for hHF (HR 0.69 vs. 0.88, p < 0.0001) and renal outcomes (HR 0.68 vs. 0.79, p = 0.026). GLP-1RAs increased retinopathy (RR 1.18, AER + 6.5/1000); SGLT-2is increased genitourinary infections (RR 3.34, AER + 19.9/1000) and DKA (RR 2.67, AER + 1.2/1000). Amputation signals attenuated post-sensitivity analysis. Net benefits favored GLP-1RAs for MACE (+ 2.5/1000). For SGLT-2is, base-case estimates using genital-mycotic infections as the sentinel harm were marginal (hHF: − 4.9/1000; renal: − 1.9/1000), whereas sensitivity scenarios with alternative harms (e.g., volume depletion, amputation, DKA) yielded positive net benefits. GRADE certainty was high for efficacy, moderate for harms. Conclusions: Our innovative integration of updated CVOTs, cross-class comparisons, and graphical risk–benefit tools refines therapeutic decision-making, highlighting tailored T2DM management based on patient-specific cardiorenal risks. Trial Registration: PROSPERO (CRD420251146788). pubtype: Academic Journal doctype: meta analysis research systematic review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|