Beyond Glycaemic Control: Efficacy and Safety of Newer Antidiabetic Agents in Patients with Cardiorenal Disease—A Narrative Review

Cardiovascular disease and chronic kidney disease are the leading causes of death in type 2 diabetes, and lowering glycated haemoglobin alone does not adequately address this risk. This narrative review summarises evidence on the glycaemic efficacy, cardiorenal outcomes and safety of sodium–glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1 RAs), the dual glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonist tirzepatide, dipeptidyl peptidase-4 inhibitors and once-weekly basal insulins, with attention to the Gulf region. PubMed/MEDLINE, ScienceDirect and Google Scholar were searched for trials, meta-analyses and guidelines published between 2015 and 2026. SGLT2i provide the most consistent reductions in heart failure hospitalisation and kidney disease progression, irrespective of diabetes status. GLP-1 RAs reduce major adverse cardiovascular events, stroke and kidney outcomes. Tirzepatide offers the greatest glycaemic and weight benefits, with cardiovascular protection comparable to an established GLP-1 RA. Dipeptidyl peptidase-4 inhibitors and weekly insulins are largely cardiorenal-neutral. Combining SGLT2i and GLP-1 RAs may provide additive protection. In the Middle East and North Africa, which has the highest diabetes prevalence worldwide, use of these organ-protective agents remains low. Therapy should be selected according to comorbidity, giving organ protection the same priority as glycaemic control.