{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T10:04:03Z","timestamp":1779789843680,"version":"3.53.1"},"reference-count":28,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Endocrino Diabet &amp;amp; Metabol"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Type 2 diabetes mellitus (T2DM) often requires combination therapy when metformin alone becomes insufficient. Empagliflozin (SGLT2 inhibitor) and sitagliptin (DPP\u20104 inhibitor) are commonly used add\u2010on agents with differing metabolic profiles. This systematic review and meta\u2010analysis compared their glycaemic, cardiometabolic and safety outcomes when added to metformin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following PRISMA guidelines, PubMed, Embase, Cochrane, Scopus and ClinicalTrials.gov were searched from inception to September 2025. Randomized trials and observational studies comparing empagliflozin\u2009+\u2009metformin versus sitagliptin\u2009+\u2009metformin 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\u2013Ottawa Scale. Random\u2010effects models were used for meta\u2010analyses, and meta\u2010regression explored the impact of empagliflozin dose.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eleven 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\u2010regression showed no meaningful dose\u2013response relationship for glycaemic or weight outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In 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\u2010on option.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>PROSPERO ID: CRD420251152360<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/edm2.70238","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T03:48:21Z","timestamp":1778644101000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Glycaemic and Cardiometabolic Outcomes of Empagliflozin Versus Sitagliptin Added to Metformin in\n                    <scp>T<\/scp>\n                    2\n                    <scp>DM<\/scp>\n                    : Insights From a Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2125-7043","authenticated-orcid":false,"given":"Saad","family":"Ashraf","sequence":"first","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7034-5594","authenticated-orcid":false,"given":"Muhammad","family":"Burhan","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Sarwar","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1176-7928","authenticated-orcid":false,"given":"Ahila","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiza","family":"Ahsan","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahzad","family":"Ashraf","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hammad","family":"Javaid","sequence":"additional","affiliation":[{"name":"Department of Medicine King Edward Medical University  Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0967-7523","authenticated-orcid":false,"given":"Hamza","family":"Irfan","sequence":"additional","affiliation":[{"name":"Department of Medicine Shaikh Khalifa Bin Zayed Al Nahyan Medical and Dental College  Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Hamza Naseer","family":"Awan","sequence":"additional","affiliation":[{"name":"Department of Medicine King Edward Medical University  Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajeet","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8285-6233","authenticated-orcid":false,"given":"Biruk Demisse","family":"Ayalew","sequence":"additional","affiliation":[{"name":"Department of 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