A Comparison of Cardiovascular Benefits of Dapagliflozin and Empagliflozin in Type 2 Diabetes: A Systematic Review and Meta-analysis

Abstract

Purpose
Dapagliflozin and Empagliflozin, two widely used sodium-glucose cotransporter 2 (SGLT2) inhibitors, are integral in managing Type 2 Diabetes Mellitus (T2DM) and have shown potential benefits in improving various clinical outcomes. This meta-analysis compares the efficacy and safety of Dapagliflozin versus Empagliflozin in T2DM patients by assessing key cardiovascular outcomes.

Methods
A comprehensive search was conducted across PubMed, EMBASE, and Cochrane databases up to February 2025. Observational studies comparing Dapagliflozin and Empagliflozin in patients with T2DM were included. Risk ratios (RR) and 95% confidence intervals (CI) were calculated for each outcome, and significance was considered when the p-value was less than 0.05. Random-effects models were used when I2 exceeded 50%, indicating substantial heterogeneity, while fixed-effects models were applied when heterogeneity was low (I2 ≤ 50%).

Results
A total of 8 studies were included in this meta-analysis, with a combined patient population of 428,940 individuals, 164,224 treated with Dapagliflozin and 264,716 treated with Empagliflozin. Dapagliflozin and Empagliflozin showed no significant differences in all-cause mortality (RR 1.10, 95% CI 0.84–1.44, p = 0.49), cardiovascular mortality (RR 0.89, 95% CI 0.65–1.23, p = 0.49), myocardial infarction (RR 0.99, 95% CI 0.82–1.20, p = 0.94), ischemic stroke (RR 1.12, 95% CI 0.96–1.30, p = 0.15), major adverse cardiovascular events (RR 1.11, 95% CI 0.94–1.30, p = 0.22), or heart failure (RR 1.10, 95% CI 0.91–1.32, p = 0.33), but Dapagliflozin was associated with a significantly lower risk of hospitalization for heart failure (RR 0.91, 95% CI 0.84–0.99, p = 0.02).

Conclusion
Dapagliflozin and Empagliflozin showed similar efficacy in managing Type 2 Diabetes outcomes, with no significant differences in mortality, cardiovascular events, or stroke. Dapagliflozin was associated with lower hospitalization rates for heart failure. Further studies are needed to evaluate long-term effects and individual patient responses.