Comparative effects of glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors on heart failure with preserved ejection fraction in diabetic patients: a meta-analysis
Authors' conclusion
GLP1-RA and SGLT2 inhibitors significantly benefit HFpEF management in T2D patients. SGLT2 inhibitors reduce myocardial fibrosis more effectively, while both improve LVEF, functional capacity, and metabolic parameters. These therapies should be integral to HFpEF management in diabetic patients. Further research is needed on long-term outcomes and potential combined therapy effects.
Study context
- Population
- Patients with T2D and Heart Failure with Preserved Ejection Fraction (HFpEF); PubMed, MEDLINE and Cochrane Library searched up to July 2024
- Participants
- 3,428 patients12 studies
- Comparison
- GLP1-RA vs SGLT2 inhibitors for HFpEF in T2D
- GLP1-RAn = 1,654
- SGLT2 inhibitorsn = 1,774
- Outcome
- Changes in left ventricular ejection fraction (LVEF), myocardial fibrosis (extracellular volume fraction, ECV) and functional capacity (6-minute walk test)
Pooled result
As reported in the abstract
LVEF, myocardial fibrosis (ECV) and 6-minute walk test
Each group vs placeboMD, % (95% CI)P value
GLP1-RALVEF
2.8(1.5–4.1)
P < 0.001SGLT2 inhibitorsLVEF
3.2(2.0–4.4)
P < 0.001SGLT2 inhibitorsMyocardial fibrosis; reduced more than with GLP1-RA
−3.5(−4.2 to −2.8)
P < 0.001GLP1-RAMyocardial fibrosis
−2.3(−3.0 to −1.6)
P < 0.001Each group vs placeboMD, m (95% CI)P value
GLP1-RA6-minute walk test
45(30–60)
P < 0.001SGLT2 inhibitors6-minute walk test
50(35–65)
P < 0.001Further pooled results
| Outcome | MD (%) (95% CI) | P value | |
|---|---|---|---|
| HbA1cGLP1-RAvs Placebo | −1.1 (−1.4 to −0.8) | P < 0.001 | |
| HbA1cSGLT2 inhibitorsvs Placebo | −1.0 (−1.3 to −0.7) | P < 0.001 | |
| −2−101Difference, % (linear scale) |
| Outcome | MD (kg) (95% CI) | P value | |
|---|---|---|---|
| Body weightGLP1-RAvs Placebo | −2.5 (−3.1 to −1.9) | P < 0.001 | |
| Body weightSGLT2 inhibitorsvs Placebo | −2.0 (−2.6 to −1.4) | P < 0.001 | |
| −4−202Difference, kg (linear scale) |
| Outcome | MD (mmHg) (95% CI) | P value | |
|---|---|---|---|
| Systolic blood pressureGLP1-RAvs Placebo | −5.2 (−6.5 to −3.9) | P < 0.001 | |
| Systolic blood pressureSGLT2 inhibitorsvs Placebo | −4.8 (−6.0 to −3.6) | P < 0.001 | |
| −10−505Difference, mmHg (linear scale) |
Original publication
Comparative effects of glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors on heart failure with preserved ejection fraction in diabetic patients: a meta-analysis. Cardiovasc Diabetol. Published 31 August 2024. doi:10.
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