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Evaluating Cardio-Protective Molecules by Efficacy Based on Weight Reduction and HbA1c Targets

Teodor Salmen1,2, Valeria-Anca Pietrosel3, Flaviana-Veronica Urzica4

  • 1Doctoral School, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.

Biomedicines
|September 27, 2025
PubMed

Insights

Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) demonstrated superior effectiveness in achieving HbA1c targets and body weight reduction in type 2 diabetes mellitus patients compared to GLP-1 receptor agonists (GLP-1 RAs). SGLT-2i showed better sustained results over 12 months.

Area of Science:

  • Endocrinology
  • Pharmacology
  • Metabolic Diseases

Background:

  • Type 2 diabetes mellitus (T2DM) management often involves multiple therapeutic strategies.
  • Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are key drug classes for T2DM.
  • Evaluating their comparative effectiveness on glycemic control and body weight is crucial.

Purpose of the Study:

  • To compare the efficacy of GLP-1 RAs and SGLT-2i in T2DM patients.
  • To assess achievement of HbA1c <7% and body weight reduction (BWR) of 5%.
  • To evaluate treatment response over 12 months in a real-world setting.

Main Methods:

  • Retrospective analysis of 405 out-patients with T2DM in Romania.
  • Data collected at baseline, 6 months, and 12 months.
  • Comparison of metformin, GLP-1 RAs, and SGLT-2i based on combined endpoint achievement.

Main Results:

  • SGLT-2i achieved significantly higher combined endpoint rates (22.7% at 12 months, p < 0.001) compared to GLP-1 RAs and metformin.
  • HbA1c reduction and BWR were more consistent with SGLT-2i over 12 months.
  • While initial HbA1c targets were met by many, BWR was less consistent, potentially influenced by insulin use.

Conclusions:

  • SGLT-2i demonstrated superior real-world efficacy in T2DM patients compared to metformin and GLP-1 RAs.
  • SGLT-2i facilitate achieving both glycemic control (HbA1c <7%) and body weight reduction (5%).
  • This highlights the significant role of SGLT-2i in modern T2DM management.
Keywords:
GLP-1 RAsSGLT-2iT2DMmetabolic controlweight loss

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