Diabetes, obesity & metabolismFeb 8, 2023

Comparing the effects of three drug types on chronic kidney disease in type 2 diabetes

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Apr 1, 2026

Abstract

SGLT-2 inhibitors were associated with a 31% lower risk of heart failure hospitalization compared to glucagon-like peptide-1 receptor agonists.

SGLT-2 inhibitors did not significantly reduce major adverse cardiovascular events compared to other treatments.
They were linked to a significantly lower risk of composite renal outcomes compared to glucagon-like peptide-1 receptor agonists and non-steroidal mineralocorticoid receptor antagonists.
Compared to glucagon-like peptide-1 receptor agonists, SGLT-2 inhibitors reduced heart failure hospitalization by 31%.
Compared to non-steroidal mineralocorticoid receptor antagonists, SGLT-2 inhibitors reduced heart failure hospitalization by 22%.
No significant differences were observed between glucagon-like peptide-1 receptor agonists and non-steroidal mineralocorticoid receptor antagonists for any outcomes.

Simplified

AIM: To compare the relative efficacy of sodium-glucose co-transporter 2 inhibitors (SGLT-2is), glucagon-like peptide-1 receptor agonists (GLP-1RAs) and non-steroidal mineralocorticoid receptor antagonists (nsMRAs) in improving the cardiovascular and renal outcomes in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD).

MATERIALS AND METHODS: We searched PubMed, Embase and Cochrane Library from inception through 25 November 2022. We selected randomized controlled trials that studied patients with CKD and T2D with a follow-up of at least 24 weeks and compared SGLT-2is, GLP-1RAs and nsMRAs with each other and with placebo. Primary outcomes were major adverse cardiovascular events (MACE) and composite renal outcomes (CRO). Secondary outcomes were cardiovascular death, all-cause death, stroke, myocardial infarction and heart failure hospitalization (HFH). A frequentist approach was used to pool risk ratios (RRs) with 95% confidence intervals (CIs).

RESULTS: Twenty-nine studies with 50 938 participants for MACE and 49 965 participants for CRO were included. SGLT-2is did not significantly reduce MACE but were associated with significantly lower risks of CRO compared with GLP-1RAs (RR, 0.77; 95% CI, 0.64-0.91; P = .003) and nsMRAs (RR, 0.78; 95% CI, 0.68-0.90; P = .001). Compared with GLP-1RAs and nsMRAs, SGLT-2is significantly reduced risks of HFH by 31% (RR, 0.69; 95% CI, 0.55-0.88; P = .002) and 22% (RR, 0.78; 95% CI, 0.63-0.95; P = .016), respectively, but did not significantly reduce other secondary outcomes. There were no significant differences between GLP-1RAs and nsMRAs in lowering all outcomes.

CONCLUSIONS: SGLT-2is were associated with better cardiorenal protection than GLP-1RAs and nsMRAs in patients with CKD and T2D.

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Comparing the effects of three drug types on chronic kidney disease in type 2 diabetes

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