Hormonal
SGLT-2 inhibitors and GLP-1 receptor agonists reduce all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and kidney failure in patients with type 2 diabetes, with absolute benefits scaling with baseline cardiovascular and renal risk.
If you have type 2 diabetes, especially with existing heart or kidney risks, adding an SGLT-2 inhibitor or GLP-1 agonist to your current regimen significantly reduces your risk of dying from heart or kidney causes. The higher your baseline risk, the greater the absolute benefit. Discuss these specific drug classes with your doctor to leverage these organ-protective effects.
Both classes of drugs lowered all cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and kidney failure (high certainty evidence)... The absolute benefits of these drugs vary substantially based on cardiovascular and renal disease risk profiles of patients with type 2 diabetes
Why this rating
High certainty evidence based on 764 RCTs and 421,346 patients using GRADE assessment.
Source
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
Suetonia C. Palmer et al. · BMJ · 2021
DOI 10.1136/bmj.m4573
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- SGLT-2 inhibitors increase the risk of genital infections, while GLP-1 receptor agonists may increase the risk of severe gastrointestinal events.Limited
- SGLT-2 inhibitors are superior to GLP-1 receptor agonists for reducing hospital admissions for heart failure, while GLP-1 receptor agonists are superior for reducing non-fatal stroke.Weak
Related findings · Hormonal
- Initial treatment for type 2 diabetes should be a combination of metformin and either an SGLT-2 inhibitor or a GLP-1 receptor agonist to achieve cardiorenal protection, rather than monotherapy or older agents like sulfonylureas.Strong
- For patients with specific monogenic obesity syndromes (leptin deficiency, POMC/PCSK1/LEPR mutations), targeted pharmacotherapy (recombinant leptin or setmelanotide) is highly effective and should be prioritized, unlike in polygenic obesity.Strong
- Continued weekly administration of 2.4 mg subcutaneous semaglutide prevents weight regain and promotes further weight loss in adults with overweight or obesity, whereas switching to placebo results in significant weight regain.Strong
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