Endocrinology

SGLT2 inhibitors markedly improve cardiorenal and hepatic outcomes in T2D with cirrhosis vs DPP-4 inhibitors

In >24,000 Taiwanese adults with type 2 diabetes and cirrhosis, SGLT2 inhibitor initiation was compared with DPP-4 inhibitor initiation. Over 2.3 years, SGLT2 inhibitors were associated with substantially lower risks of ESKD, AKI, and MACE versus DPP-4 inhibitors. SGLT2 inhibitor use also correlated with reduced all-cause mortality and fewer hepatic decompensation events. These real-world data support SGLT2 inhibitors as preferred agents over DPP-4 inhibitors for complex patients with concurrent T2D and cirrhosis, where not contraindicated. 1

GLP-1 receptor agonists reduce heart failure hospitalization vs DPP-4 inhibitors and equal SGLT2 inhibitors

This Swedish target-trial emulation compared new GLP-1 receptor agonist starts with DPP-4 inhibitors and SGLT2 inhibitors in routine T2D care. Versus DPP-4 inhibitors, GLP-1 receptor agonists lowered 3-year heart failure hospitalization risk, with a weighted HR of 0.77. Heart failure hospitalization risk was similar between GLP-1 receptor agonists and SGLT2 inhibitors, with a weighted HR of 1.02. GLP-1 receptor agonists also showed lower major adverse cardiovascular events versus DPP-4 inhibitors, aligning with trial data. Findings support GLP-1 receptor agonists as heart-failure–neutral versus SGLT2 inhibitors and superior to DPP-4 inhibitors for heart failure prevention. 2

Tirzepatide delivers cardiovascular benefit comparable to GLP-1 receptor agonists in high-risk T2D

This network meta-analysis pooled 11 cardiovascular outcome trials in type 2 diabetes with established ASCVD or high cardiovascular risk. Class-level analysis showed tirzepatide significantly reduced MACE, cardiovascular mortality, all-cause mortality, nonfatal MI, and nonfatal stroke versus placebo. Agent-level analysis found tirzepatide reduced MACE versus placebo and versus lixisenatide. Formal head-to-head comparative statistics versus the GLP-1 receptor agonist class were not feasible, but point estimates were numerically favorable. Overall, tirzepatide appears to provide at least GLP-1–comparable cardiovascular protection in high-risk type 2 diabetes populations. 3

Gestational diabetes predicts broad metabolic, autoimmune, cancer, and gynecologic risks over 5–10 years

Using TriNetX, four large propensity-matched cohorts of women with and without gestational diabetes were assembled after childbirth. Within five years, gestational diabetes markedly increased risk of type 2 diabetes and other metabolic outcomes including hypertriglyceridemia, obesity, and sleep apnea. Autoimmune diseases, including type 1 diabetes, Graves disease, and psoriasis, were also more frequent after gestational diabetes. Gynecologic conditions such as PCOS, uterine fibroids, and endometriosis were more common, and 10-year adiposity-related cancer risk modestly increased. These data argue for structured long-term surveillance and aggressive risk-factor modification after gestational diabetes, beyond traditional short-term follow-up. 4