Real‐World Comparison of Cardiorenal Outcomes With
SGLT
‐2 Inhibitors Versus
GLP
‐1 Receptor Agonists in Type 2 Diabetes
Chieh‐Hsin Huang, Jia‐Ling Wu, Tsai‐Chieh Ling, Avery Shuei‐He Yang, Shang‐Han Wu, Ching‐Chiao Huang, Edward Chia‐Cheng Lai, Yu‐Tzu Chang ABSTRACT
Aims
To compare cardiorenal outcomes, mortality and safety between sodium‐glucose cotransporter‐2 inhibitors (SGLT‐2i) and glucagon‐like peptide‐1 receptor agonists (GLP‐1 RA) in adults with Type 2 diabetes (T2D).
Materials and Methods
We conducted a retrospective, new‐user cohort study using the TriNetX global federated health research network. We identified 249 237 propensity score‐matched pairs (498 474 total patients) who initiated SGLT‐2i or GLP‐1 RA between 2018 and 2023. The primary outcome was a kidney failure/death composite, defined as kidney failure, dialysis, kidney transplantation or all‐cause mortality. Secondary outcomes included composite cardiovascular events, mortality and safety profiles.
Results
SGLT‐2i initiation was associated with a lower risk of the kidney failure/death composite compared with GLP‐1 RA (HR: 0.87, 95% CI: 0.85–0.89). For the kidney‐specific component, SGLT‐2i initiation was associated with a lower risk of kidney failure, dialysis or kidney transplantation (HR: 0.74, 95% CI: 0.71–0.78), while all‐cause mortality was also lower (HR: 0.90, 95% CI: 0.88–0.93). The composite cardiovascular outcome (myocardial infarction, stroke, acute heart failure, cardiogenic shock, cardiac arrest or death) was broadly comparable between groups (HR: 0.98, 95% CI: 0.97–1.00).
Conclusions
SGLT‐2i initiation was associated with lower risks of kidney failure‐related outcomes and all‐cause mortality compared with GLP‐1 RA initiation, while cardiovascular outcomes were broadly comparable. These findings may inform individualized treatment selection in adults with T2D.