Real‐World Comparison of Cardiorenal Outcomes With SGLT ‐2 Inhibitors Versus GLP ‐1 Receptor Agonists in Type 2 Diabetes

AIMS: To compare cardiorenal outcomes, mortality and safety between sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) in adults with Type 2 diabetes (T2D). MATERIALS AND METHODS: We conducted a retrospective, new-user cohort study using the TriNetX global federated health research network. We identified 249 237 propensity score-matched pairs (498 474 total patients) who initiated SGLT-2i or GLP-1 RA between 2018 and 2023. The primary outcome was a kidney failure/death composite, defined as kidney failure, dialysis, kidney transplantation or all-cause mortality. Secondary outcomes included composite cardiovascular events, mortality and safety profiles. RESULTS: SGLT-2i initiation was associated with a lower risk of the kidney failure/death composite compared with GLP-1 RA (HR: 0.87, 95% CI: 0.85-0.89). For the kidney-specific component, SGLT-2i initiation was associated with a lower risk of kidney failure, dialysis or kidney transplantation (HR: 0.74, 95% CI: 0.71-0.78), while all-cause mortality was also lower (HR: 0.90, 95% CI: 0.88-0.93). The composite cardiovascular outcome (myocardial infarction, stroke, acute heart failure, cardiogenic shock, cardiac arrest or death) was broadly comparable between groups (HR: 0.98, 95% CI: 0.97-1.00). CONCLUSIONS: SGLT-2i initiation was associated with lower risks of kidney failure-related outcomes and all-cause mortality compared with GLP-1 RA initiation, while cardiovascular outcomes were broadly comparable. These findings may inform individualized treatment selection in adults with T2D.