The comparative efficacy of SGLT-2 inhibitors and GLP-1 receptor agonists on metabolic benefits in T2DM patients: a systematic review and network meta-analysis

Jan 31, 2026European journal of medical research

Comparing the metabolic benefits of two diabetes drug types in type 2 diabetes patients

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Abstract

GLP-1 receptor agonists were associated with a 1.08 kg greater weight loss compared to SGLT-2 inhibitors in adults with type 2 diabetes.

GLP-1 receptor agonists showed a stronger weight-loss effect in individuals with a BMI of 30 kg/m² or greater, with a mean difference of -1.11 kg.
For individuals with a BMI between 30 kg/m² and 35 kg/m², GLP-1 receptor agonists led to a weight loss of -0.95 kg compared to SGLT-2 inhibitors.
SGLT-2 inhibitors were more effective in reducing diastolic blood pressure, achieving a decrease of -1.35 mmHg compared to placebo.
Both GLP-1 receptor agonists and SGLT-2 inhibitors lowered triglyceride levels, with reductions of -0.14 mmol/L and -0.12 mmol/L, respectively.
GLP-1 receptor agonists were found to decrease LDL cholesterol levels by -0.14 mmol/L, unlike SGLT-2 inhibitors.

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BACKGROUND: SGLT-2 inhibitors and GLP-1 receptor agonists exhibit metabolic benefits on improving obesity, diabetes, hypertension and hyperlipidemia, but the differences between them remain unclear. We evaluated the comparative efficacy of these two agents on metabolic benefits in adults with T2DM.

METHOD: This study has searched the electronic databases from the inception of the databases up to March 30, 2025. Primary outcome was the efficacy for weight loss. Secondary outcomes included the effectiveness for HbAlevels, blood pressure, and plasma lipid levels. We conducted a Bayesian network meta-analysis. This protocol was cataloged with PROSPERO (CRD42021247584). 1c

RESULTS: 168 RCTs of 72,195 adults were deemed eligible. For losing weight, GLP-1 receptor agonists were more effective than SGLT-2 inhibitors (MD - 1.08 kg,95% CrI: - 1.78 to -0.36). In subgroup analyses, compared to SGLT-2 inhibitors, GLP-1 receptor agonists displayed a stronger weight-loss effect in subgroup of 30 kg/m ≤ BMI < 35 kg/m(- 0.95 kg, - 1.91 to - 0.01) and BMI ≥ 35 kg/m(- 1.11 kg, - 6.73 to - 4.60), while had a weaker weight-loss effect in subgroup of 25 kg/m ≤ BMI < 30 kg/m(1.33 kg, 0.79-1.83). For lowering plasma glucose, GLP-1 receptor agonists showed a stronger effect on reducing HbAlevel (- 0.38%,- 0.52 to - 0.25). For decreasing blood pressure, both GLP-1 receptor agonists (- 2.10 mmHg, - 3.66 to - 0.49) and SGLT-2 inhibitors (- 3.20 mmHg, - 4.0 to - 2.39) decreased systolic blood pressure, while only SGLT-2 inhibitors (- 1.35 mmHg, - 1.67 to - 1.01) decreased diastolic blood pressure compared to placebo. For regulating serum lipids, both GLP-1 receptor agonists (- 0.14 mmol/L, - 0.22 to - 0.08) and SGLT-2 inhibitors (- 0.12 mmol/L, - 0.18 to - 0.07) lowered triglycerides, while only GLP-1 receptor agonists lowered LDL-c level (- 0.14 mmol/L, - 0.22 to - 0.06) compared to placebo. 2 2 2 2 2 1c

CONCLUSION: Both GLP-1 receptor agonists and SGLT-2 inhibitors have been shown to confer metabolic benefits. GLP-1 receptor agonists displayed stronger effects on weight reduction for patients with obesity (BMI ≥ 30 kg/m), lowering HbAlevels and improving lipid profiles. SGLT-2 inhibitors demonstrated greater efficacy in losing weight for patients with overweight (25 kg/m2 ≤ BMI < 30 kg/m2) and decreasing blood pressure. 2 1c

REGISTRATION NUMBER: CRD42021247584. The name of the registry: PROSPERO. The URL to the registration: https://www.crd.york.ac.uk/PROSPERO/.

Key numbers

1.08 kg

Weight Loss Increase

Mean difference in weight loss between drug classes.

3.20 mmHg

Systolic Blood Pressure Decrease

Reduction in systolic blood pressure by SGLT-2 inhibitors.

0.14 mmol/L

LDL-c Reduction

Reduction in LDL-c levels by GLP-1 receptor agonists.

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The comparative efficacy of SGLT-2 inhibitors and GLP-1 receptor agonists on metabolic benefits in T2DM patients: a systematic review and network meta-analysis

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