Abstract

Background
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 March 2025. Observational studies comparing Dapagliflozin and Empagliflozin in patients with T2DM were included. Odds ratios (OR) 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 was used when I² exceeded 50%, indicating substantial heterogeneity, while fixed-effect model was 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. The analysis revealed no significant difference in all-cause mortality between Dapagliflozin and Empagliflozin (OR 1.10, CI 0.84-1.45, p=0.49). Regarding heart failure outcomes, Empagliflozin demonstrated a slight advantage over Dapagliflozin, although this difference did not reach statistical significance (OR 1.10, CI 0.91-1.33, p=0.33). Both drugs showed comparable effects in reducing cardiovascular mortality, with no significant differences observed (OR 0.89, CI 0.64-1.24, p=0.49). The comparison for ischemic stroke also revealed no significant difference between the two treatments (OR 1.12, CI 0.96-1.30, p=0.15). Furthermore, both Dapagliflozin and Empagliflozin had similar impacts on Major Adverse Cardiovascular Events (OR 1.11, CI 0.94-1.32, p=0.22) and myocardial infarction rates (OR 0.99, CI 0.82-1.20, p=0.95). Regarding hospitalization for heart failure, Dapagliflozin showed a trend towards lower rates, as compared to Empagliflozin (OR 0.91, 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.