EASD 2020 Highlights

Conference summaries


Cardiovascular outcomes of patients with type 2 diabetes treated with SGLT-2 inhibitors versus GLP-1 receptor agonists in real life

Presented by:

Gian Paolo Fadini, MD

  • In this real-world analysis, SGLT-2 inhibitors protected from hospitalisation for heart failure more than GLP1-RAs.
  • Better outcomes were seen in 3P-MACE with SGLT-2 inhibitors vs. GLP-1 RAs.

What do we already know about this topic?

  • According to American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) consensus, SGLT-2 inhibitors should be preferred over GLP-1 receptor agonists (GLP-1 RAs) in patients with a high risk of established atherosclerotic cardiovascular disease (ACVD), heart failure (HF), or chronic kidney disease (CKD) if HF or CKD predominates.1
  • However, this view has recently been challenged since both classes may offer benefits to reduce adverse cardiovascular (CV) events, but SGLT-2 inhibitors are preferred for patients with HF.2
  • This view also sustains that renal function is improved by both classes, but low eGFR is an important determinant of eligibility, and issues of safety, cost, and individual preferences of clinicians and patients will have a strong impact when choosing between them.2

How was this study conducted?

  • This observational, retrospective study compared CV outcomes of patients who received SGLT-2 inhibitors or a GLP-1 RA in real-world settings.
  • Registry data was used from the Veneto region in northeast Italy.
  • Between 2014 and 2018, 7192 patients initiated a SGLT-2 inhibitor and 5804 initiated a GLP-1 RA.
  • Propensity score matching was used to create two cohorts with identical baseline characteristics (4298 patients in each).
  • Outcomes were collected on laboratory parameters, CV outcomes and adverse events.

What does this study add?

  • Mean age was 63 years with a mean duration of diabetes of 9.5 years and mean HbA1c of 7.9%, and treated with a mean of 2.3 classes of glucose-lowering medications.
  • Median follow-up was 13 months.
  • GLP-1 RAs reduced HbA1c more than SGLT-2 inhibitors, while SGLT-2 inhibitors improved systolic blood pressure and HDL-cholesterol more than GLP-1 RAs (Fig. 1).
  • Rates of 3 points major adverse cardiovascular events (3P-MACE) were lower among new users of SGLT-2 inhibitors than new users of GLP-1 RAs (HR 0.78, 95% CI 0.61-0.99, p = 0.043).
  • Rates of hospitalisation for HF were also lower among new users of SGLT-2 inhibitors than new users of GLP-1 RAs (HR 0.59, 95% CI 0.35-0.99, p = 0.048)
  • There were no significant differences in overall adverse events.


How does this study impact clinical practice?

  • Consistent with the literature, SGLT-2 inhibitors protect from hospitalisation for HF more than GLP1-RAs, especially in patients without CV disease at baseline.
  • The finding that better outcomes were seen in 3P-MACE with SGLT-2 inhibitors compared to GLP-1 RAs was unexpected.
  • However, the anti-atherosclerotic effects are supported by pre-clinical studies.
  • These data have a moderate level of evidence to help guide clinicians in the choice of agent in new users of a SGLT-2 inhibitor or GLP-1 RA.



  1. Buse JB, Wexler DJ, Tsapas A, et al. 2019 update to: management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2020 Feb;63(2):221-8.
  2. Bailey CJ. Choosing GLP-1 receptor agonists or SGLT-2 inhibitors by cardiorenal risk. Lancet Diabetes Endocrinol. 2020 Feb;8(2):97-9.


Related content



This is a highlights summary of an oral session given at the EASD 2020 Virtual Meeting and presented by:

Gian Paolo Fadini, MD
Dept. of Medicine, University of Padova, Italy

The presenting authors of the original session had no part in the creation of this conference highlights summary. 

The content is produced by Infomedica. The summary text was drafted by Patrick Moore, PhD, and reviewed by Marco Gallo, MD, an independent external expert, and approved by Florian Toti, MD, the scientific editor of the program.


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