Choosing the right medicine for type 2 diabetes is becoming more complicated because many newer drugs provide benefits beyond lowering blood sugar. Some medicines help people lose weight, while others protect the heart or kidneys.
For patients who also have atrial fibrillation, doctors have had little evidence to show which treatment may offer the greatest overall benefit. A new study from the University at Buffalo may help answer that question.
The research was published in Diabetes Research and Clinical Practice and compared two of today’s most commonly prescribed diabetes drug families. The first group was glucagon-like peptide-1 receptor agonists, commonly called GLP-1 drugs.
This group includes medicines such as semaglutide, which is sold as Ozempic and Wegovy, and liraglutide. These medicines lower blood sugar, reduce appetite, and often help people lose weight.
The second group was sodium-glucose cotransporter-2 inhibitors, known as SGLT-2 inhibitors. These medicines include empagliflozin, sold as Jardiance, and dapagliflozin, sold as Farxiga. They work by helping the kidneys remove extra sugar from the body and have become important treatments for heart failure and chronic kidney disease.
The study focused on people who had both type 2 diabetes and atrial fibrillation. Atrial fibrillation is an irregular heartbeat that can cause blood to pool inside the heart.
This increases the chance of blood clots, stroke, heart failure, and other serious health problems. When diabetes and atrial fibrillation occur together, the risk of complications becomes much higher than having either condition alone.
Researchers led by Dr. Md Mohaimenul Islam and Dr. Arinze Nkemdirim Okere examined electronic medical records from 108 health systems across the United States. They identified more than 36,000 patients and carefully matched two equal groups.
One group began treatment with a GLP-1 medicine, while the other started an SGLT-2 inhibitor. This made it the largest direct comparison of these medicines in people with both conditions.
After following patients for one year, the researchers found that those receiving GLP-1 medicines generally experienced better overall health outcomes. Compared with patients taking SGLT-2 inhibitors, they had a 36 percent lower risk of dying from any cause.
They were also less likely to be admitted to hospital, had fewer major cardiovascular events such as heart attack and stroke, and were less likely to require a medical procedure to control atrial fibrillation.
The improvements were seen in younger and older patients as well as in people with different body weights. This suggests the findings may apply to a wide range of patients who have both diabetes and atrial fibrillation.
Although the results appear impressive, the researchers were careful not to overstate their conclusions. They emphasized that SGLT-2 inhibitors remain excellent medicines, especially for people who already have heart failure or progressive kidney disease.
Large clinical trials have repeatedly shown that these medicines improve survival and reduce hospital admissions in those patients. For this reason, current treatment guidelines continue to recommend SGLT-2 inhibitors as first-line therapy for many people with these conditions.
The authors also explained that their study cannot prove that GLP-1 medicines directly caused the better outcomes. This was an observational study that analysed existing medical records rather than assigning treatments randomly.
Doctors may have prescribed one medicine instead of another for reasons that were not fully captured in the database. In addition, the follow-up period lasted only one year, so the study could not measure long-term benefits or risks.
Even with these limitations, the research fills an important gap because doctors previously had very little evidence to guide treatment decisions for patients living with both diabetes and atrial fibrillation.
Instead of suggesting that one medicine is always better, the findings support choosing treatment based on each person’s overall health, including obesity, kidney function, heart failure, and other medical conditions.
This study is valuable because it uses a very large group of real-world patients from across the United States, making the results relevant to everyday clinical practice. However, observational studies cannot establish cause and effect as strongly as randomized clinical trials. Future trials directly comparing these medicines would provide stronger evidence.
For now, the study suggests that GLP-1 medicines may offer extra protection for many patients with both atrial fibrillation and type 2 diabetes who do not already have advanced heart failure or kidney disease, while SGLT-2 inhibitors remain an essential treatment for patients with those conditions.
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Source: University at Buffalo.
