898-P: SGLT2 Inhibitors or GLP-1 Receptor Agonists? Development of a Personalized Treatment Algorithm for Individuals with Type 2 Diabetes

• Published in: Diabetes (New York, N.Y.) Vol. 74; no. Supplement_1; p. 1
• Main Authors: MORI, TIM, KUSS, OLIVER, MADER, JULIA K., SEUFERT, JOCHEN, HOLL, REINHARD W., LANZINGER, STEFANIE, GRIMSMANN, JULIA M.
• Format: Journal Article
• Language: English
• Published: New York American Diabetes Association 20.06.2025
• Subjects: Agonists; Algorithms; Angina; Antidiabetics; Arteriosclerosis; Cardiovascular diseases; Diabetes; Diabetes mellitus (non-insulin dependent); Epidermal growth factor receptors; GLP-1 receptor agonists
• ISSN: 0012-1797; 1939-327X
• DOI: 10.2337/db25-898-P

Introduction and Objective: Guidelines recommend GLP-1 receptor agonists (GLP-1-RA) and SGLT2 inhibitors (SGLT2i) for individuals with type 2 diabetes (T2D) at high risk of atherosclerotic cardiovascular disease (ASCVD). We aimed to develop a personalized treatment algorithm to guide the initial decision between these therapies. Methods: Using data from the Diabetes Prospective Follow-up registry (Germany/Austria) we studied individuals with T2D who initiated GLP-1-RA (n=823) or SGLT2i (n=1,566) in a multicenter, real-world setting. Dual users were excluded. Baseline characteristics included age, sex, BMI, eGFR, HbA1c, diabetes duration, and history of ASCVD. Non-fatal ASCVD events (MI, angina, revascularization, stroke, TIA, PAD) were analyzed using dynamic weighted survival modeling to predict the optimal treatment for each individual. Results: Based on a linear decision rule (Figure), the algorithm predicted 48% of individuals to have better ASCVD outcomes with GLP-1-RA and 52% with SGLT2i. GLP-1-RA-optimal individuals had on average a higher BMI (37 vs 31 kg/m²), lower eGFR (71 vs 93 ml/min per 1.73 m2) and less history of ASCVD (9 vs 18%) compared to SGLT2i-optimal individuals. Conclusion: Simple clinical features (BMI, eGFR, history of ASCVD) can guide personalized treatment recommendations to prevent non-fatal ASCVD complications in T2D.