{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T19:01:47Z","timestamp":1790276507880,"version":"4.1.0"},"reference-count":78,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>This systematic review aimed to evaluate the cardiovascular effectiveness and safety of initiating sodium-glucose cotransporter 2 inhibitors (SGLT2i) in comparison to glucagon-like peptide 1 receptor agonists (GLP-1RA) among elderly patients with diabetes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A comprehensive search of the PubMed, Embase, and Web of Science databases was conducted up to March 2024. The summary standard mean differences and odds ratios were calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twelve studies of eleven articles were included in the analysis. Older patients receiving SGLT2i had a greater incidence of euglycemic ketoacidosis (EKA) (OR 1.622, 95% CI 1.276-2.062, p = 0.000) and genitourinary infection (GUI) (OR 3.59, 95% CI 3.31-3.89, p = 0.00) than did those receiving GLP-1RA, and the opposite was true for acute kidney injury (AKI) (OR 0.902, 95% CI 0.854 - 0.952, p = 0.00). However, no significant differences were detected for major adverse cardiovascular events (MACE) (OR 1.04, 95% CI 0.95-1.13, p = 0.386), hospitalization for heart failure (HHF) (OR 0.98 95% CI 0.83-1.16, p = 0.825), myocardial infarction (MI) (OR 1.09, 95% CI 0.94-1.26, p = 0.265), stroke (OR 1.22, 95% CI 1.02-1.45, p = 0.028), total adverse events (AEs), (OR 0.98, 95% CI 0.83-1.16, p = 0.825), serious AEs (OR 1.02, 95% CI 0.94 -1.11, p = 0.594), fractures (OR 1.07, 95% CI 0.92-1.24, p = 0.394) or hypoglycemia (OR 0.95, 95% CI 0.88-1.02, p = 0.141).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In conclusion, although SGLT2i increase the risk of EKA and GUI and GLP-1RA decrease the risk of AKI, SGLT2i are at comparable risk of MACE, HHF, MI, stroke, hypoglycemia, and fracture to GLP-1RA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic review registration<\/jats:title><jats:p><jats:uri>https:\/\/www.crd.york.ac.uk\/PROSPERO\/<\/jats:uri>, identifier CRD42024518348.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1486655","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T04:13:59Z","timestamp":1756181639000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Comparative effectiveness and safety of sodium-glucose cotransporter 2 inhibitors vs glucagon-like peptide 1 receptor agonists in elderly patients with type 2 diabetes mellitus: a meta-analysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Yao","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoming","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingxian","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongling","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyu","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yibo","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.2337\/dc12-1801","article-title":"Diabetes in older adults","volume":"35","author":"Kirkman","year":"2012","journal-title":"Diabetes Care"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.2337\/dci19-0066","article-title":"2019 update to: management of hyperglycemia in type 2 diabetes, 2018. 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