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SGLT-2is and GLP-1RAs significantly reduce heart failure related composite endpoints in type 2 diabetesSGLT2 inhibitors and GLP-1RAs both improve heart failure outcomes

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Key Takeaway
Consider SGLT-2is and GLP-1RAs as preferred glycemic control strategies to improve cardiovascular outcomes in T2DM with HF.

This network meta-analysis evaluated the efficacy of SGLT-2is, GLP-1RAs, DPP-4 inhibitors, and GIP/GLP-1RAs in patients with type 2 diabetes and heart failure. The study included 13,886 patients to assess cardiovascular and renal outcomes. The analysis found that SGLT-2is significantly reduced heart failure related composite endpoints (HR 0.75; 95% CI [0.68, 0.82]) and heart failure hospitalization (HR 0.74; 95% CI [0.66, 0.83]) compared to placebo. Similarly, GLP-1RAs significantly reduced heart failure related composite endpoints (HR 0.77; 95% CI [0.61, 0.97]).

There was no statistically significant difference between SGLT-2is and GLP-1RAs (HR 0.98; 95% CI [0.76, 1.25]). SGLT-2is were associated with a reduction in cardiovascular death (HR 0.87; 95% CI [0.77, 0.98]) and a trend toward reduced all-cause death (HR 0.83; 95% CI [0.67, 1.02]), though the latter did not reach statistical significance. Regarding renal outcomes, SGLT-2is did not show a statistically significant benefit for the renal composite outcome (HR 0.76; 95% CI [0.51, 1.14]).

The authors note that further evidence is needed to confirm definitive renal benefits for SGLT-2is. Clinically, both SGLT-2is and GLP-1RAs are identified as preferred glycemic control strategies for improving cardiovascular outcomes in patients with type 2 diabetes and heart failure.

How this fits prior evidence

This network meta-analysis confirms the role of SGLT-2is and GLP-1RAs as effective interventions for heart failure in patients with type 2 diabetes. While the study does not directly address the biomarkers of kidney function decline or the effects of mineralocorticoid receptor antagonists on coronary microvascular function mentioned in prior coverage, it provides high-level evidence for the cardiovascular benefits of SGLT-2is and GLP-1RAs in this specific patient population.

Living with both type 2 diabetes and heart failure creates a complex challenge for managing daily health. New data helps clarify which medications might offer the best protection for the heart. A large analysis of over 13,000 patients compared several types of drugs, including SGLT2 inhibitors and GLP-1RAs, against a placebo.

The results show that both SGLT2 inhibitors and GLP-1RAs significantly reduced the risk of heart failure complications. Specifically, SGLT2 inhibitors lowered the risk of heart failure worsening and hospitalizations. While both types of drugs performed well, the study found no significant difference in effectiveness between SGLT2 inhibitors and GLP-1RAs.

While these medications show strong promise for heart health, some results are still unclear. For example, while SGLT2 inhibitors showed a trend toward reducing all-cause death, the result was not statistically significant. Additionally, the data did not show a clear, significant benefit for kidney outcomes. More research is needed to confirm exactly how these drugs affect kidney health.

What this means for you:
Both SGLT2 inhibitors and GLP-1RAs effectively reduce heart failure risks in patients with type 2 diabetes.

Common questions

How do SGLT2 inhibitors and GLP-1RAs compare for heart failure?

Both SGLT2 inhibitors and GLP-1RAs significantly reduced the risk of heart failure complications compared to a placebo. The study found no statistically significant difference in effectiveness between these two types of medications for patients with type 2 diabetes and heart failure.

Do SGLT2 inhibitors help with heart failure hospitalization?

Yes, the data shows that SGLT2 inhibitors significantly reduced the risk of heart failure hospitalization. They also showed a significant reduction in the risk of heart failure worsening and cardiovascular death for patients with type 2 diabetes.

Are there any confirmed benefits for kidney health with these drugs?

While SGLT2 inhibitors were studied for kidney outcomes, the results did not show a statistically significant benefit for the renal composite outcome. More evidence is still needed to confirm if these medications provide definitive benefits for the kidneys.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
ObjectiveThis study aims to evaluate the cardiovascular and renal benefits of novel hypoglycemic agents, including glucagon-like peptide-1 receptor agonists (GLP-1RAs), dipeptidyl peptidase-4 inhibitors (DPP-4is), sodium-glucose cotransporter-2 inhibitors (SGLT-2is), and glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 dual receptor agonists (GIP/GLP-1RAs) in patients with type 2 diabetes mellitus (T2DM) and heart failure (HF).MethodsSystematic literature searches were conducted in MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to 30 April 2026. Randomized controlled trials (RCTs) for cardiovascular outcomes (CVOTs) or post hoc analyses of CVOTs comparing SGLT-2is, DPP-4is, GLP-1RAs, or GIP/GLP-1RAs in patients with T2DM and HF were selected. Network meta-analysis was used for indirect comparisons, with results presented as hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsA total of 10 RCTs and two post hoc analyses of CVOTs involving 13,886 patients were included. Compared with placebo, SGLT-2is (HR [95% CI]: 0.75 [0.68, 0.82]) and GLP-1RAs (HR [95% CI]: 0.77 [0.61, 0.97]) both significantly reduced the risk of HF-related composite endpoints in patients with T2DM and HF. No statistically significant difference was observed between SGLT-2is and GLP-1RAs (HR [95% CI]: 0.98 [0.76, 1.25]). SGLT-2is also reduced the risk of HF worsening (HR [95% CI]: 0.72 [0.53, 0.96]), HF hospitalization (HR [95% CI]: 0.74 [0.66, 0.83]), and cardiovascular (CV) death (HR [95% CI]: 0.87 [0.77, 0.98]). For all-cause death, SGLT-2is showed a trend toward reduced risk compared to placebo, but this difference did not reach statistical significance (HR [95% CI]: 0.83 [0.67, 1.02]). For the renal composite outcome, SGLT-2is did not demonstrate a statistically significant benefit (HR [95% CI]: 0.76 [0.51, 1.14]).ConclusionOptimal clinical management of T2DM requires a comprehensive assessment of cardiovascular and renal comorbidities. This network meta-analysis indicates that SGLT-2is significantly reduce the risk of HF-related composite endpoints and CV death in T2DM patients with HF, although their renoprotective effect does not reach statistical significance. GLP-1RAs also demonstrate beneficial effects on HF-related composite endpoints. These findings suggest that both SGLT-2is and GLP-1RAs are preferred glycemic control strategies for improving cardiovascular outcomes in T2DM patients with HF, while further evidence is needed to confirm their definitive renal benefits.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42026142123, identifier: CRD420261421235.
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