Comparison of SGLT-2i and GLP-1RA on cardiovascular and renal outcomes in elderly patients with T2DM: a single-center retrospective cohort study

Sep 5, 2025International urology and nephrology

Comparing two diabetes medicines and their effects on heart and kidney health in older adults with type 2 diabetes

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Abstract

Among 1,015 elderly type 2 diabetes patients, SGLT-2 inhibitors reduced the risk of adverse renal outcomes more effectively than GLP-1 receptor agonists.

No significant difference in the risk of major cardiovascular events was observed between SGLT-2 inhibitors and GLP-1 receptor agonists.
SGLT-2 inhibitors showed a statistically significant reduction in composite adverse renal outcomes compared to GLP-1 receptor agonists.
Both treatment groups experienced significant improvements in glycemic control and body mass index after 24 months.
GLP-1 receptor agonists were associated with a greater reduction in body mass index than SGLT-2 inhibitors.
The overall rate of adverse events did not differ significantly between the two groups.

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PURPOSE: While SGLT-2i and GLP-1RA show cardiorenal benefits, their comparative efficacy in elderly type 2 diabetes mellitus (T2DM) patients remains uncertain. This study aimed to compare SGLT-2i and GLP-1RA on cardiovascular and renal outcomes in elderly T2DM patients.

METHODS: This retrospective study analyzed 1,015 propensity score-matched elderly T2DM patients (SGLT-2i group: n = 583; GLP-1RA group: n = 432). Medical records were collected to assess cardiovascular/renal outcomes, glycemic parameters [(fasting plasma glucose (FPG), 2-h postprandial blood glucose (2hPBG), homeostatic model assessment of insulin resistance (HOMA-IR), and hemoglobin A1c (HbA1c)], body mass index (BMI), and adverse reactions. A Cox regression model was constructed to analyze the impact of SGLT-2i and GLP-1RA on 3-point major adverse cardiovascular events (3P-MACE: non-fatal myocardial infarction, stroke, and cardiovascular death) and adverse renal outcomes (persistent decline in eGFR by 40%, end-stage renal disease, or death due to renal disease) across subgroups.

RESULTS: The two groups were similar in baseline clinical characteristics. The risk of 3P-MACE was not markedly different between the SGLT-2i and GLP-1RA groups (P = 0.071), while SGLT-2i demonstrated a superior performance in reducing the risk of composite adverse renal outcomes (P = 0.014). Both groups achieved significant glycemic improvements and BMI reduction at 24 months post-treatment (all P < 0.05), with greater BMI reduction in GLP-1RA (P < 0.05). The two groups did not differ markedly in overall adverse events (P > 0.05). No marked differences were found in 3P-MACE or adverse renal composite outcomes across the predefined subgroups (all P > 0.05).

CONCLUSION: In elderly T2DM patients, SGLT-2i and GLP-1RA contributed to similar cardiovascular outcomes, but SGLT-2i was associated with a lower risk of composite adverse renal outcomes.

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Comparison of SGLT-2i and GLP-1RA on cardiovascular and renal outcomes in elderly patients with T2DM: a single-center retrospective cohort study

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