# Effect of Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists and Sodium-Glucose Cotransporter-2 (SGLT-2) Inhibitors on Atherosclerotic Cardiovascular Risk Among Patients With Type 2 Diabetes in Primary Health Care Settings in Jeddah, Saudi Arabia

## TL;DR

This study examines how GLP-1 receptor agonists and SGLT-2 inhibitors affect cardiovascular risk in type 2 diabetes patients in Saudi Arabia.

## Contribution

The study evaluates the impact of GLP-1 and SGLT-2 drugs on atherosclerotic cardiovascular risk in a Saudi population with type 2 diabetes.

## Key findings

- Significant improvements in HbA1c levels and systolic blood pressure were observed.
- Estimated glomerular filtration rate increased modestly, but albuminuria remained unchanged.
- No significant reduction in cardiovascular events was found during follow-up.

## Abstract

Background

Saudi Arabia has one of the highest global prevalences of diabetes mellitus (39.5%), with cardiovascular disease (CVD) representing the leading cause of mortality among patients with diabetes. Sodium-glucose cotransporter 2 (SGLT-2) inhibitors (e.g., dapagliflozin) and glucagon-like peptide-1 receptor agonists (GLP-1RAs; e.g., semaglutide) have demonstrated cardiorenal benefits; however, their effect on 10-year atherosclerotic cardiovascular disease (ASCVD) risk in Saudi populations remains underexplored.

Methods

This retrospective cohort study included 196 adults aged 40 to 79 years with type 2 diabetes who were prescribed dapagliflozin or semaglutide at King Saud Bin Abdulaziz Medical City between March 2021 and March 2022. Patients with type 1 diabetes, established CVD, or chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m²) were excluded. Data on demographic characteristics, metabolic parameters (HbA1c, lipid profile, estimated glomerular filtration rate), and cardiovascular events were collected at baseline and at six, nine, and 12 months. Statistical analyses were performed using paired t-tests and McNemar’s test and IBM SPSS Statistics for Windows, Version 28 (Released 2021; IBM Corp., Armonk, New York, United States).

Results

The mean age of the studied population was 57.4±11.3 years, and 70.9% were female participants. Significant improvements were observed in HbA1c levels (from 8.9±1.1% to 7.4±0.8%; P<0.001) and systolic blood pressure (from 137±17 to 131±17 mmHg; P=0.004). Estimated glomerular filtration rate showed a modest increase (from 91±18 to 92±18 mL/min/1.73 m²; P<0.001), while albuminuria remained unchanged. Rates of cardiovascular events, including myocardial infarction and stroke, did not differ significantly during follow-up (P>0.05).

Conclusions

Treatment with dapagliflozin and semaglutide was associated with significant improvements in glycemic control and systolic blood pressure but was not associated with a reduction in short-term cardiovascular events in this high-risk cohort. Long-term studies are warranted to assess the impact of these agents on ASCVD risk reduction in this population.