A new study has found that people with type 2 diabetes who take semaglutide—a drug commonly known by its brand names Ozempic and Wegovy—may have a slightly lower risk of stroke compared to those taking empagliflozin, another widely used diabetes medication.
The findings, published in the Annals of Internal Medicine, come from a large international analysis of real-world patient data and provide fresh insight into the cardiovascular safety profiles of these medications.
Researchers examined health data from 7,899 patients treated with semaglutide and compared them to a matched group of 7,899 patients who received empagliflozin. All participants were 45 or older, had type 2 diabetes, and had other health conditions that put them at higher risk of cardiovascular events. The study covered prescription records from January 2019 to December 2024.
The analysis showed that patients taking semaglutide had a slightly lower overall risk of major cardiovascular events—including death, heart attack (myocardial infarction), and stroke—compared to those on empagliflozin. This modest benefit was mostly due to a reduced risk of stroke among semaglutide users.
The researchers also evaluated a second group of 6,093 patients who were treated with dulaglutide, another GLP-1 receptor agonist like semaglutide. These patients were also matched to 6,093 empagliflozin users. In contrast to semaglutide, dulaglutide did not show a significant advantage over empagliflozin in reducing the risk of death, heart attack, or stroke.
Both studies used a method called target trial emulation, a way of using real-world data to closely mimic the conditions of a clinical trial. Patients were carefully matched using propensity score methods, meaning they were similar in health status and risk factors at the start of the study—except that semaglutide users tended to have a slightly higher body mass index.
Importantly, the risk difference between semaglutide and empagliflozin became more noticeable after one year of treatment, especially for stroke outcomes.
While all secondary risk measures—including heart failure and atrial fibrillation—also favored semaglutide, the difference was not large. The study did not suggest semaglutide eliminated the risk of these conditions but did offer small improvements compared to empagliflozin.
Subgroup analysis showed that the benefits of semaglutide were more pronounced in younger patients (under age 65) and in those who had well-controlled blood sugar levels (HbA1c under 7%).
Dr. Avery Brown, one of the study authors from the University of Pittsburgh, emphasized that the findings help refine the understanding of how different diabetes medications perform in real-world settings. While clinical trials often show large benefits under ideal conditions, real-life use often shows more modest outcomes.
In summary, the study supports semaglutide as a slightly more favorable option for reducing the risk of stroke in people with type 2 diabetes—especially in younger, well-managed patients—compared to empagliflozin.
However, dulaglutide does not appear to offer the same advantage. These findings can help doctors make more personalized treatment decisions for patients managing both diabetes and cardiovascular risk.
If you care about diabetes, please read studies about diabetes and vitamin B12, and the right diet for people with type 2 diabetes.
For more health information, please see recent studies about how to eat smart with diabetes, and turmeric and vitamin D: a duo for blood pressure control in diabetic patients.
The research findings can be found in Annals of Internal Medicine.
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