Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science


Internal Medicine


Thomas Colletti


Purpose: Preventing complications such as diseases related to renal and cardiovascular disease are an important part of managing patients with Type 2 diabetes (DM2). The initial gold standard monotherapy for DM2 is metformin. However, sodium glucose co-transporter 2 inhibitors (SGLT-2) and glucagon-like peptide 1 agonists (GLP-1) classes of medication have changed the direction in lowering glucose with added benefits. Research has much to say about the risks versus benefits of treating DM2 with SGLT-2 and GLP-1 antidiabetic medications versus metformin.

Method: The purpose of this review of literature is to conduct a systematic review of the advantages and disadvantages of SGLT-2 inhibitors and GLP-1 receptor agonists, compared with metformin in patients with DM2. A search was conducted with search terms of “SGLT-2 inhibitors”, “GLP-1 agonists”, “Metformin”, and a secondary search including “cardiovascular protection in type 2 diabetes”, “kidney disease prevention in type 2 diabetes”. Thirty-two articles were selected to perform this review and twenty-two articles were excluded after the full-text review. Among excluded articles, two were found to be in a non-English language, eleven articles were reviews of studies already included in the literature review, and nine other articles did not fulfill the inclusion criteria of metformin versus SGLT-2 inhibitors and GLP-1 receptor agonists in the management of DM2 with other risk factors.

Results: Research provides evidence that shows the effectiveness of metformin as a monotherapy versus SGLT-2 inhibitor and GLP-1 receptor agonists and the risks versus benefits associated with the most optimal outcomes available for DM2. There is reliable evidence to suggest that SGLT-2 inhibitors and GLP-1 receptor agonists offer superior benefits when compared to metformin alone. This review demonstrates the advantages of SGLT-2 inhibitors and GLP-1 receptor agonists compared with metformin.

Conclusion: The findings of this systematic literature review suggest, that in the secondary prevention of cardiovascular and renal events in patients with DM2, dual treatment with SGLT-2 inhibitors or GLP-1 receptor agonists in conjunction with metformin demonstrate a significant advantage and enhanced safety profile over metformin as a monotherapy in reducing the risk of renal injury and adverse cardio vascular event.


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