Guidelines Recommend SGLT-2 and GLP-1 Therapies Primarily for Adults at Elevated Risk of Heart and Kidney Issues

Recent guidelines published in The BMJ emphasize that SGLT-2 inhibitors and GLP-1 receptor agonists should be predominantly prescribed to adults with type 2 diabetes who are at moderate to high risk of cardiovascular and renal complications. An international panel of experts reviewed extensive evidence—including nearly half a million adults across 869 randomized trials—and concluded that these medications offer significant benefits in reducing heart and kidney risks for these populations.

The recommendation highlights that for individuals at lower risk of such complications, routine use of SGLT-2 and GLP-1 therapies may not be appropriate. Instead, personalized treatment discussions between doctors and patients are encouraged to consider individual risk profiles and preferences.

For adults with diabetes and chronic kidney disease, finerenone is advised when the risk of complications is high, as its benefits tend to outweigh potential risks. However, this medication is not recommended for those at moderate risk.

Weight management remains a key focus; for obese adults with diabetes, combining weight loss strategies with risk reduction is crucial. The guideline advocates for the use of tirzepatide due to its superior effects on weight loss, although clinicians should weigh its benefits against the cardiovascular and kidney advantages offered by GLP-1 receptor agonists, based on patient-specific factors.

In higher-risk patients, tirzepatide should generally complement rather than replace established therapies like GLP-1 receptor agonists, ensuring that the primary medications targeting heart and kidney health are maintained or initiated.

This living guideline aims to inform clinicians worldwide by utilizing the GRADE framework for evidence quality assessment. It also features an interactive decision aid, MATCH-IT, designed to support shared decision-making.

Developed from a comprehensive systematic review and network meta-analysis, these recommendations recognize the challenges posed by medication availability and costs across different healthcare systems. Professor Per Olav Vandvik emphasizes the importance of global collaboration on continuously updated evidence to improve policy and clinical practice, akin to efforts during the COVID-19 pandemic.

The authors encourage adaptation and dissemination of these guidelines through international initiatives like the Alliance for Living Evidence (ALIVE) and the Evidence Synthesis Infrastructure Collaborative (ESIC). They also commit to regular updates as new data emerge, ensuring that treatment recommendations remain current and applicable worldwide.

Source: https://medicalxpress.com/news/2025-08-experts-sglt-glp-adults-moderate.html