Effectiveness of SGLT2 Inhibitors in Type 2 Diabetes: A Systematic Integrative Review of Reviews and Comparative Effectiveness Studies (2020–2025)

TL;DR

This review summarizes evidence from recent studies on how well SGLT2 inhibitors work for managing type 2 diabetes, heart health, and kidney function.

Contribution

A systematic integrative review of recent studies (2020–2025) on SGLT2 inhibitors, highlighting their comparative effectiveness in glucose, cardiovascular, and renal outcomes.

Findings

SGLT2 inhibitors effectively reduce glucose levels but with variable magnitude compared to other antidiabetic drugs.

They significantly lower cardiovascular mortality and heart failure hospitalizations compared to DPP-4 inhibitors and placebo.

Consistent renal benefits include reduced risk of acute kidney injury and slowed progression of chronic kidney disease.

Abstract

This systematic integrative review evaluates the effectiveness of SGLT2 inhibitors in relation to improving glycaemic control, reducing cardiovascular events, and preserving renal function based on the latest published evidence. Search for publications referenced in PubMed, from January 2020 to January 2025, was conducted; 48 abstracts were reviewed, and 27 full-text articles were included for analysis—systematic reviews, meta-analyses, narrative reviews and comparative effectiveness studies. SGLT2 inhibitors are effective in reducing glucose levels, but the magnitude of reduction varies compared to other classes of antidiabetics. A noticeable reduction in the risk of major cardiovascular events, cardiovascular and all-cause mortality was reported, particularly compared to DPP-4 inhibitors and placebo. SGLT2 inhibitors demonstrated the most pronounced and consistent benefits in reducing hospitalisation for heart failure among all other evaluated classes. However, outcomes like myocardial infarction and stroke results were inconsistent. Renal outcomes consistently favoured SGLT2 inhibitors in reducing the risk of acute kidney injury, slowing chronic kidney disease and lowering the risk of end-stage kidney disease. SGLT2 inhibitors provide consistent glucose-lowering, cardiovascular and renal benefits. However, heterogeneity in study designs, patient populations, and treatment durations does not allow drawing definitive conclusions and highlights the need for future research focused on conducting well-designed trials with standardised methodology.

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