GLP-1 receptor agonists vs. SGLT-2 inhibitors:\xa0the gap seems to be leveling off

Dario Giugliano,Katherine Esposito,Giuseppe Bellastella,Miriam Longo,Lorenzo Scappaticcio

doi:10.1186/s12933-021-01400-9

Abstract

Cardiovascular disease (CVD) remains the leading cause of death in patients with type 2 diabetes (T2D). Older age, prior heart failure (HF) and CV events, peripheral artery disease, and kidney complications can identify a subgroup of patients with T2D at high risk of mortality who are likely to achieve the greatest benefit from newer glucose-lowering agents. Both glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 (SGLT-2) inhibitors can reduce CV risk in patients with T2D, and both are recommended by the American Diabetes Association to reduce the risk of major cardiovascular events (MACE). The magnitude of the benefits of GLP-1RA and SGLT-2 inhibitors on MACE are similar, ranging from 12 to 14% reduction of risk, but only GLP-1RA may reduce the risk of stroke. The most striking difference between the two classes of drugs relates to the amelioration on hospitalization for HF, as the benefit of SGLT-2 inhibitors surpass by threefold that obtained with GLP-1RA. Despite this, GLP-1RA also exert a significant benefit on HF which suggest their use when SGLT-2 inhibitors are contraindicated or not tolerated. The difference between the two classes is less impressive for the kidney outcome. Overall, the results of CVOTs published so far seems to suggest that the gap between the cardiorenal benefits of SGLT-2 and GLP-1RA is narrowing.

Highlights

Cardiovascular disease (CVD) remains the leading cause of death in patients with type 2 diabetes (T2D)
*Correspondence: dario.giugliano@unicampania.it 1 Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy Full list of author information is available at the end of the article cohort of 16,492 patients with T2D and at high/very high CV risk participating in the SAVOR-TIMI 53 trial [6], cardiovascular disease (CVD) remained the leading cause of death and approximately one-third of all deaths were classified as sudden
Prior heart failure (HF) and CV events, peripheral artery disease, and kidney complications can identify a subgroup of patients with T2D at high risk of mortality who are likely to achieve the greatest benefit from aggressive management of modifiable risk factors and newer glucose-lowering agents

Summary

Introduction

Cardiovascular disease (CVD) remains the leading cause of death in patients with type 2 diabetes (T2D). *Correspondence: dario.giugliano@unicampania.it 1 Division of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy Full list of author information is available at the end of the article cohort of 16,492 patients with T2D and at high/very high CV risk participating in the SAVOR-TIMI 53 trial [6], CVD remained the leading cause of death and approximately one-third of all deaths were classified as sudden.

Results

Conclusion