Evidence mapPaperPMID 42120997Full record

SynthesisEndocrinology, diabetes & metabolism2026

Glycaemic and Cardiometabolic Outcomes of Empagliflozin Versus Sitagliptin Added to Metformin in T2DM: Insights From a Systematic Review and Meta-Analysis.

Saad Ashraf, Muhammad Burhan, Sara Sarwar, Ahila Ali, Aiza Ahsan, Shahzad Ashraf, Hammad Javaid, Hamza Irfan, Muhammad Hamza Naseer Awan, Ajeet Singh and 1 more

Abstract readSystematic ReviewMeta-Analysis
In one paragraph

Synthesis in Endocrinology, diabetes & metabolism, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
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

0 citing papers in PubMed.

No citing paper in PubMed yet.

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

11 authors.

Saad AshrafDepartment of Medicine, Dow University of Health Sciences, Karachi, Pakistan.ORCID https://orcid.org/0000-0003-2125-7043
Muhammad BurhanDepartment of Medicine, Dow University of Health Sciences, Karachi, Pakistan.ORCID https://orcid.org/0009-0005-7034-5594
Sara SarwarDepartment of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Ahila AliDepartment of Medicine, Dow University of Health Sciences, Karachi, Pakistan.ORCID https://orcid.org/0009-0003-1176-7928
Aiza AhsanDepartment of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Shahzad AshrafDepartment of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Hammad JavaidDepartment of Medicine, King Edward Medical University, Lahore, Pakistan.
Hamza IrfanDepartment of Medicine, Shaikh Khalifa Bin Zayed Al Nahyan Medical and Dental College, Lahore, Pakistan.ORCID https://orcid.org/0000-0002-0967-7523
Muhammad Hamza Naseer AwanDepartment of Medicine, King Edward Medical University, Lahore, Pakistan.
Ajeet SinghDepartment of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Biruk Demisse AyalewDepartment of Internal Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.ORCID https://orcid.org/0009-0006-8285-6233

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundType 2 diabetes mellitus (T2DM) often requires combination therapy when metformin alone becomes insufficient. Empagliflozin (SGLT2 inhibitor) and sitagliptin (DPP-4 inhibitor) are commonly used add-on agents with differing metabolic profiles. This systematic review and meta-analysis compared their glycaemic, cardiometabolic and safety outcomes when added to metformin.

methodsFollowing PRISMA guidelines, PubMed, Embase, Cochrane, Scopus and ClinicalTrials.gov were searched from inception to September 2025. Randomized trials and observational studies comparing empagliflozin + metformin versus sitagliptin + metformin in adults with T2DM were included. Primary outcomes were changes in HbA1c, body weight, fasting glucose, lipid profile and blood pressure. Safety outcomes included urinary tract infections, genital infections, gastrointestinal disturbances and rash. Risk of bias was assessed using RoB 2.0 and the Newcastle-Ottawa Scale. Random-effects models were used for meta-analyses, and meta-regression explored the impact of empagliflozin dose.

resultsEleven studies met eligibility criteria. Empagliflozin produced greater reductions in HbA1c, body weight, fasting glucose and systolic blood pressure compared with sitagliptin. Lipid changes were modest and inconsistent. Rates of urinary infections, gastrointestinal symptoms and rash were comparable between groups, whereas genital infections were significantly higher with empagliflozin. Rare but serious adverse events associated with SGLT2 inhibitors, including Fournier's gangrene and lower limb amputations, were not reported in the included trials. Meta-regression showed no meaningful dose-response relationship for glycaemic or weight outcomes.

conclusionsIn patients with T2DM on metformin, empagliflozin offers superior glycaemic and cardiometabolic benefits compared with sitagliptin, with an increase in genital infections. Both therapies are well tolerated, supporting empagliflozin as an effective metabolic add-on option.

trial registrationPROSPERO ID: CRD420251152360.

Indexed as

Benzhydryl CompoundsDiabetes Mellitus, Type 2GlucosidesHypoglycemic AgentsMetforminSitagliptin PhosphateSodium-Glucose Transporter 2 InhibitorsBlood GlucoseDrug Therapy, CombinationGlycated HemoglobinHumansTreatment OutcomeBenzhydryl CompoundsBlood GlucoseempagliflozinGlucosidesGlycated HemoglobinHypoglycemic AgentsMetforminSitagliptin PhosphateSodium-Glucose Transporter 2 Inhibitorscardiometabolic outcomesempagliflozinmeta‐analysismetforminsitagliptintype 2 diabetes

Identifiers

PMID42120997
PMCPMC13167695

What Socratic holds

Texttitle and abstract
LicenceCC BY
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.