Tang EHM, Wong CKH, Lau KTW, et al. - According to this population-based cohort study, patients starting sodium glucose cotransporter-2 inhibitors (SGLT2i) had a significantly lower risk of heart failure than those starting glucagon-like peptide-1 receptor agonists (GLP-1RA), as well as better glycemic control via a greater reduction in fasting glucose level over one-year follow-up, while direct medical cost incurred was similar to that of GLP-1RA.

• The Hong Kong Hospital Authority identified patients with type 2 diabetes.

• Patients were included if they were free of cardiovascular and end-stage renal disease at the start of treatment with SGLT2i (n = 2,541) or GLP-1RA (n = 303).

• Over a median follow-up of 12.5 months in the SGLT2i group and 25.5 months in the GLP-1RA group, SGLT2i users had a significantly reduced risk of heart failure than GLP-1RA users.

• One-year change in clinical parameters also favored use of SGLT2i over GLP-1RA, where the former was linked to a larger decline in fasting glucose level.

• After a year of follow-up, the two groups had comparable direct medical costs.