Long-term effects of metformin versus sodium glucose transporter 2 inhibitors on cardiovascular outcomes in patients with type 2 diabetes.

Abstract

Objectives: To compare the long-term cardiovascular effects of Metformin and sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with type 2 diabetes mellitus (T2DM).

Methods: A retrospective study was conducted on 692 T2DM patients treated between January 2020 and January 2023. Patients were divided into two groups: SGLT2i group (n = 460) and Metformin group (n = 232) according to their treatment protocol. Data on demographics, blood glucose/lipid profiles, echocardiographic parameters, and cardiovascular outcomes were collected over a 2-year follow-up period. Outcomes included myocardial infarction (MI), stroke, mortality, and hospitalization for heart failure (HHF).

Results: Both treatments significantly reduced blood glucose levels, with Metformin showing greater improvements in glycated hemoglobin (HbA1c). SGLT2i demonstrated superior reductions in triglycerides and total cholesterol levels. Echocardiography revealed enhanced diastolic function with SGLT2i. Moreover, SGLT2i significantly reduced MI and HHF risk, though safety profiles were similar except for higher genital infection incidence in the SGLT2i group.

Conclusions: While Metformin remains effective for glycemic control, SGLT2i offers distinct cardiovascular benefits, notably in reducing the risks of MI and HHF.