Comparison of the Effects of SGLT-2i versus GLP-1RA on Cardiovascular and Renal Outcomes in Patients with Type 2 Diabetes Mellitus based on Baseline Renal Function

There remained no head-to-head research to evaluate the cardiovascular and renal benefits of sodium-glucose cotransporter 2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) in patients with type 2 diabetes mellitus (T2DM) at different baseline renal function. We performed a network meta-analysis to compare the two drugs indirectly. Systematic literature searches were conducted on PubMed, Cochrane Library, Web of Science, and Embase, covering their inception until January 7, 2025. Randomized controlled trials (RCTs) comparing the effects of SGLT-2i and GLP-1RA in T2DM with different glomerular filtration rates (eGFR) were selected. Results were reported as Risk ratios (RR) with corresponding 95% confidence intervals (CI). Finally, 10 RCTs involving 87,334 T2DM patients were included. In conclusion, In patients with eGFR > 90 mL/min/1.73m², GLP-1RA exhibited a superior ability to reduce the risk of all-cause death (ACD) compared to SGLT-2i (RR [95% CI]; 0.75 [0.58, 0.97]), but was less effective in reducing the risk of renal outcome (RR [95% CI]; 1.80 [1.15, 2.84]) in patients with eGFR 60-90 mL/min/1.73m². Conversely, in patients with eGFR 30-60 and 60-90 mL/min/1.73m², GLP-1RA did not show an advantage in reducing the risk of hospitalization for heart failure (HHF) (RR [95% CI]; 1.87 [1.15, 3.04] and 1.37 [1.05, 1.78], respectively).