Evidence map›Paper›PMID 41504379›Full record

SynthesisDiabetes, obesity & metabolism2026

Sex differences in trial representation and the cardiovascular effectiveness of newer glucose-lowering agents in patients with and without type 2 diabetes: A systematic review and meta-analysis of cardiovascular outcome trials.

Magdaline Zawadka, Erwin Taguiam, Mê-Linh Lê, Rohan Sanjanwala, Shuangbo Liu, Ashish H Shah, Setor K Kunutsor

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Diabetes, obesity & metabolism, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Magdaline ZawadkaSection of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Erwin TaguiamSection of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Mê-Linh LêNeil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada.
Rohan SanjanwalaDepartment of Internal Medicine, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
Shuangbo LiuSection of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Ashish H ShahSection of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Setor K KunutsorSection of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.ORCID 0000-0002-2625-0273

Funding

Cardiology Research Development Fund of the Section of Cardiology, University of ManitobaUniversity Research Grants Program (URGP) of the University of Manitoba
6 · The paper itself

Abstract

aimsThe extent to which the cardiovascular benefits of sodium-glucose co-transporter 2 inhibitors (SGLT-2is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) differ by sex remains unclear. This systematic meta-analysis aimed to investigate sex differences in trial representation and the cardiovascular and kidney efficacy of SGLT-2is and GLP-1RAs in patients with and without type 2 diabetes (T2D). MATERIALS AND

methodsCardiovascular outcome trials (CVOTs) were identified through searches in MEDLINE, Embase, and CENTRAL, and manual search of ClinicalTrials.gov up to August 2025. Sex-specific hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled using random-effects meta-analysis. Sex-differential treatment effects were assessed using the ratio of HRs and meta-regression.

resultsAcross 47 articles from 25 unique CVOTs (n > 185 000) published between 2015 and 2025, women were less represented (approximately one-third of trial participants). SGLT-2is and GLP-1RAs significantly reduced cardio-kidney outcomes in both men and women. In individuals with T2D, SGLT-2is significantly reduced risks of major adverse cardiovascular events (MACE) 0.87 (0.80-0.95) and composite cardiovascular death or hospitalization for heart failure 0.73 (0.64-0.83) in men, with broadly similar results for women and also for both sexes in individuals without T2D. In individuals with T2D, GLP-1RAs reduced MACE risk in men 0.89 (0.82-0.96) and women 0.83 (0.77-0.91). Pooled ratio of HRs showed no significant sex differences, though some cardiovascular benefits appeared slightly greater in women; formal interactions were not statistically significant.

conclusionsSGLT-2is and GLP-1RAs provide broadly comparable cardio-kidney benefits across sexes in patients with and without T2D. The lower representation of women in CVOTs warrants attention.

Indexed as

Cardiovascular DiseasesDiabetes Mellitus, Type 2Hypoglycemic AgentsSodium-Glucose Transporter 2 InhibitorsClinical Trials as TopicFemaleGlucagon-Like Peptide-1 Receptor AgonistsHumansMaleSex FactorsTreatment OutcomeGlucagon-Like Peptide-1 Receptor AgonistsHypoglycemic AgentsSodium-Glucose Transporter 2 Inhibitorscardiovascular diseaseGLP‐1RAkidney eventsrandomized controlled trialsexSGLT‐2itype 2 diabetes

Identifiers

PMID41504379
PMCPMC12890774

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.