Journal Club: Comparative Effects of SGLT-2 and DPP-4 Inhibitors Added to Metformin

Course overview

Diabetes mellitus (DM) affects over 38 million U.S. adults and 589 million worldwide, driving vascular complications and high healthcare costs. The ADA Standards emphasize lifestyle modification, self-management education, and individualized therapy. Metformin remains first-line in specific patients, while GLP-1 receptor agonists and SGLT-2 inhibitors are prioritized in patients with cardiovascular disease, heart failure, or chronic kidney disease. In a 12-week randomized trial, empagliflozin and sitagliptin improved glycemia when added to metformin, but empagliflozin achieved greater reductions in fasting glucose, A1C, weight, blood pressure, and triglycerides, and increased HDL-C. These results reinforce SGLT-2 inhibitors as preferred agents in patients with cardiometabolic risk.