Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials

SPS commentary:

In terms of differences, SGLT-2 inhibitors reduced mortality and admission to hospital for heart failure more than GLP-1 receptor agonists, and GLP-1 receptor agonists reduced non-fatal stroke more than SGLT-2 inhibitors (which appeared to have no effect). SGLT-2 inhibitors caused genital infection (high certainty), whereas GLP-1 receptor agonists might cause severe gastrointestinal events (low certainty).

This review was conducted as part of the BMJ Rapid Recommendations project, a collaborative initiative from the MAGIC (Making GRADE the Irresistible Choice) Evidence Ecosystem Foundation and The BMJ. The aim of the initiative is to provide trustworthy practice guidelines within months of newly released evidence, underpinned by rigorous evidence summaries. The researchers note that the balance of benefits and harms depends on individual risk profiles of patients, and thus the results support a risk stratified approach for provision of SGLT-2 inhibitors and GLP-1 receptor agonists to patients with type 2 diabetes. Accordingly, the forthcoming associated BMJ Rapid Recommendations will provide risk stratified recommendations and highlight the need for shared decision making to allow patients and clinicians to make well informed decisions together.