Tight blood-glucose control via traditional therapies does not significantly reduce macrovascular outcomes or heart failure risk in type 2 diabetes, whereas SGLT2 inhibitors and GLP-1 agonists significantly reduce cardiovascular mortality and heart failure hospitalization.

The majority of previous, large, multicentre, randomized-controlled trials such as UKPDS, ADVANCE, ACCORD and VADT did not demonstrate an improvement in macrovascular outcomes with tight blood-glucose control... Similarly, a meta-analysis of data from eight randomized trials comprising 37,229 people with T2D revealed no observed benefit of intensive glycaemic control on HF-related outcomes... SGLT2 inhibitors have emerged as glucose-lowering therapies showing improved cardiovascular outcomes in T2D... In the first of these, the EMPA-REG OUTCOME and CANVAS studies, there was a relative risk reduction in cardiovascular mortality and hospitalization for HF... In the randomized-controlled LEADER trial, patients with T2D and high cardiovascular risk treated with liraglutide had lower rates of cardiovascular death compared with those having placebo.