Metformin Plus SGLT2 Inhibitor Versus DPP-4 Inhibitor: Comparative Effects on Weight and Blood Pressure

Abstract

Combination strategies are increasingly used when metformin monotherapy is insufficient. In a pragmatic randomized cohort, adding an SGLT2 inhibitor to metformin produced greater weight loss and systolic blood pressure reductions than adding a DPP-4 inhibitor, with similar glycemic control. Genitourinary adverse events were more frequent in the SGLT2 group but were mostly mild and self-limited. Treatment selection should consider cardiometabolic targets and patient preferences.