Preprints.org · Oct 29, 2026

Beyond Glycaemic Control: Efficacy and Safety of Newer Antidiabetic Agents in Patients with Cardiorenal Disease—A Narrative Review

By Alqallaf SM

Cardiovascular disease and chronic kidney disease are the leading causes of death in type 2 diabetes, and lowering glycated haemoglobin alone does not adequately address this risk. This narrative review summarises evidence on the glycaemic efficacy, cardiorenal outcomes and safety of sodium–glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1 RAs), the dual glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonist tirzepatide, dipeptidyl peptidase-4 inhibitors and once-weekly basal insulins, with attention to the Gulf region. PubMed/MEDLINE, ScienceDirect and Google Scholar were searched for trials, meta-analyses and guidelines published between 2015 and 2026. SGLT2i provide the most consistent reductions in heart failure hospitalisation and kidney disease progression, irrespective of diabetes status. GLP-1 RAs reduce major adverse cardiovascular events, stroke and kidney outcomes. Tirzepatide offers the greatest glycaemic and weight benefits, with cardiovascular protection comparable to an established GLP-1 RA. Dipeptidyl peptidase-4 inhibitors and weekly insulins are largely cardiorenal-neutral. Combining SGLT2i and GLP-1 RAs may provide additive protection. In the Middle East and North Africa, which has the highest diabetes prevalence worldwide, use of these organ-protective agents remains low. Therapy should be selected according to comorbidity, giving organ protection the same priority as glycaemic control.

doi.org/10.20944/preprints202610.2993.v1Open accessInterventions