Key Benefits and Risks of Medications for Adults with Type 2 Diabetes

A living systematic review and network meta-analysis evaluated 869 trials with 493,168 adults to assess 13 drug classes (63 drugs) for type 2 diabetes. Evidence confirms kidney and cardiovascular benefits for sodium-glucose cotransporter-2 (SGLT-2) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), and finerenone (for

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patients with chronic kidney disease). Tirzepatide and orforglipron were most effective for weight reduction. Medication-specific risks include:

• SGLT-2 inhibitors: increased genital infections, diabetic ketoacidosis due to diabetes, and possible amputations
• GLP-1RAs/tirzepatide: increased severe gastrointestinal events (Highest risk with tirzepatide)
• Finerenone: increased severe hyperkalemia
• Thiazolidinediones: increased fractures and possible heart failure hospitalizations
• Sulfonylureas, insulin, DPP-4 inhibitors: increased risk of severe hypoglycemia

Evidence is limited or uncertain for effects on neuropathy, vision, and dementia. 

Reference:

Nong K, Jeppesen BT, Shi Q, Agoritsas T, Guyatt GH, White H, Gao Y, Agarwal A, Macdonald H, Zou X, Millard T. Medications for adults with type 2 diabetes: a living systematic review and network meta-analysis. bmj. 2025 Aug 14;390.

https://www.bmj.com/content/390/bmj-2024-083039