Meta-analysis: SGLT2 inhibitors outperform GLP-1 drugs for heart failure and kidney protection in diabetes | Research

The takeaway

In a meta-analysis of 33 RCTs, both SGLT2 inhibitors and GLP-1 drugs reduced cardiovascular and kidney outcomes, but network meta-analysis showed SGLT2i conferred greater reductions in heart failure hospitalization and kidney composite outcomes than incretin-based therapies.

SGLT2i > GLP-1 for kidneys/HF
Network meta-analysis shows SGLT2 inhibitors confer greater reductions in heart failure hospitalization and kidney outcomes than GLP-1 drugs in T2D

What the researchers found

NMA: SGLT2i reduced HF hospitalization and kidney outcomes more than incretin therapies in T2D+ASCVD/high CV risk and CKD. Incretin therapies uniquely reduced HF events in HFpEF with obesity. Both classes reduced MACE, CV mortality, all-cause mortality, MI, and stroke in T2D+ASCVD. SGLT2i benefits extended to acute HF and post-MI.

Why it matters

Clinicians need to know which drug to prescribe first for cardiorenal protection. This analysis suggests SGLT2 inhibitors should be prioritized for heart failure and kidney protection, while GLP-1 drugs may be preferred for obese HFpEF patients.

How the study worked

Systematic search of MEDLINE/CENTRAL (Jan 2023-Apr 2025) plus prior meta-analyses. 33 RCTs included. Random-effects meta-analysis plus network meta-analysis comparing drug classes.

What this study cannot tell us

Network meta-analysis relies on indirect comparisons (no head-to-head trials). Population overlap across included trials. Tirzepatide grouped with GLP-1 drugs. Subgroup analyses may be underpowered.

How to read the evidence

Meta-analysis and NMA of 33 RCTs—high-quality evidence synthesis. Indirect NMA comparisons should be interpreted cautiously pending head-to-head trials.

When this study was published

Published in 2025; includes data through April 2025.

The bigger picture

This analysis helps resolve the "which drug first" question for cardiorenal protection in diabetes. While both classes are valuable, their strengths differ—SGLT2i for heart and kidney, incretins for weight and atherosclerosis—supporting combination strategies.

Questions still open

Should all T2D patients receive both SGLT2i and GLP-1RA?
Do the advantages of SGLT2i for kidneys persist in non-diabetic CKD?
How should finerenone be sequenced with SGLT2i and GLP-1 drugs?

Common questions

Which is better for the heart: SGLT2 inhibitors or GLP-1 drugs?

Both help, but in different ways. This analysis shows SGLT2 inhibitors are better at preventing heart failure hospitalizations and kidney problems, while GLP-1 drugs are better for reducing atherosclerotic events (heart attacks, strokes) and weight. Many patients may benefit from taking both.

Should I take both types of drugs?

Combination therapy is increasingly recommended for patients with type 2 diabetes and high cardiovascular or kidney risk. This analysis shows the benefits are additive—each drug class addresses different aspects of cardiorenal risk. Your doctor can determine the best combination based on your specific health needs.

Read the original research

Effectiveness of SGLT2 inhibitors, incretin-based therapies, and finerenone on cardiorenal outcomes: a meta-analysis and network meta-analysis.

Cardiovascular diabetology. Endocrinology reports, 11(1), 37

View on PubMed ↗Publisher’s paper ↗

Citation

Shokravi, Arveen; Seth, Jayant; Lu, Nelson; Mancini, G B John. (2025). Effectiveness of SGLT2 inhibitors, incretin-based therapies, and finerenone on cardiorenal outcomes: a meta-analysis and network meta-analysis.. Cardiovascular diabetology. Endocrinology reports, 11(1), 37. https://doi.org/10.1186/s40842-025-00248-2