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.
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Data availability
All data generated or analysed during this study are included in this article.
Code availability
The custom code and software applications used in this study are available from the corresponding author upon reasonable request. All computational methods and tools used in the analysis comply with standard practices in the field and are sufficient to support the claims made in the manuscript. The authors confirm that all data, materials, and relevant software have been appropriately described and made available in accordance with journal policies and disciplinary standards.
References
Goyal R, Singhal M, Jialal I. Type 2 diabetes. [Updated 2023 Jun 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513253/. Accessed 24 Sept 2025.
Hossain MJ, Al-Mamun M, Islam MR. Diabetes mellitus, the fastest growing global public health concern: early detection should be focused. Health Sci Rep. 2024;7(3):e2004. https://doi.org/10.1002/hsr2.2004.
Baldassarre MPA, Paolucci T, Park K, Pipino C. Editorial: Preventing cardiovascular complications of type 2 diabetes. Front Endocrinol (Lausanne). 2024;15:1473603. https://doi.org/10.3389/fendo.2024.1473603.
Siam NH, Snigdha NN, Tabasumma N, Parvin I. Diabetes mellitus and cardiovascular disease: exploring epidemiology, pathophysiology, and treatment strategies. Rev Cardiovasc Med. 2024;25(12):436. https://doi.org/10.31083/j.rcm2512436.
Guan H, Tian J, Wang Y, et al. Advances in secondary prevention mechanisms of macrovascular complications in type 2 diabetes mellitus patients: a comprehensive review. Eur J Med Res. 2024;29(1):152. https://doi.org/10.1186/s40001-024-01739-1.
Ferrannini E, Cushman WC. Diabetes and hypertension: the bad companions. Circulation. 2022;146(16):1231–1233. https://doi.org/10.1161/CIR.0000000000001258.
Patel R, Sina RE, Keyes D. Lifestyle modification for diabetes and heart disease prevention. [Updated 2024 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK585052/. Accessed 12 Mar 2025.
American Diabetes Association Professional Practice Committee . 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(Supplement_1):S181-S206. https://doi.org/10.2337/dc25-S009
Ni L, Yuan C, Chen G, Zhang C, Wu X. SGLT2i: beyond the glucose-lowering effect. Cardiovasc Diabetol. 2020;19:1.
Wiviott SD, Raz I. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019;380:347–57.
Fitchett D, Zinman B. Heart failure outcomes with empagliflozin in patients with type 2 diabetes at high cardiovascular risk: results of the EMPA-REG OUTCOME® trial. Eur Heart J. 2016May 14;37(19):1526–34.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. Published online March 29, 2021:n71. https://doi.org/10.1136/bmj.n71
Higgins JPT, Altman DG, Gotzsche PC, et al. The cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343(oct18 2):d5928. https://doi.org/10.1136/bmj.d5928.
Lo CKL, Mertz D, Loeb M. Newcastle-Ottawa Scale: comparing reviewers’ to authors’ assessments. BMC Med Res Methodol. 2014Apr;1(14):45.
Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60. https://doi.org/10.1136/bmj.327.7414.557.
Engström A, Söderling J, Hviid A, Eliasson B, Gudbjörnsdottir S, Wintzell V, et al. Comparative cardiovascular and renal effectiveness of empagliflozin and dapagliflozin: scandinavian cohort study. European Heart Journal-Cardiovascular Pharmacotherapy. 2024;10(5):432–43.
Bonnesen K, Heide-Jørgensen U, Christensen DH, Lash TL, Hennessy S, Matthews A, et al. Comparative cardiovascular effectiveness of empagliflozin versus dapagliflozin in adults with treated type 2 diabetes: a target trial emulation. Circulation. 2024Oct 29;150(18):1401–11.
Lim J, Hwang IC, Choi HM, Yoon YE, Cho GY. Comparison of cardiovascular and renal outcomes between dapagliflozin and empagliflozin in patients with type 2 diabetes. MedRxiv. 2022;25:2022–105.
Lim J, Choi YJ, Kim BS, Rhee TM, Lee HJ, Han KD, et al. Comparative cardiovascular outcomes in type 2 diabetes patients taking dapagliflozin versus empagliflozin: a nationwide population-based cohort study. Cardiovasc Diabetol. 2023Jul 26;22(1):188.
Park JI, Kim U, Park JS. Comparison of clinical outcomes between dapagliflozin versus empagliflozin in patients with diabetes mellitus. J Am Coll Cardiol. 2022;79(9_Supplement):677. https://doi.org/10.1016/S0735-1097(22)01668-0.
Shao SC, Chang KC, Hung MJ, Yang NI, Chan YY, Chen HY, et al. Comparative risk evaluation for cardiovascular events associated with dapagliflozin vs. empagliflozin in real-world type 2 diabetes patients: a multi-institutional cohort study. Cardiovasc Diabetol. 2019;18:1–5.
Kim JH, Yoon YC, Kim YH, Park JI, Choi KU, Nam JH, et al. Cardiovascular outcomes between dapagliflozin versus empagliflozin in patients with diabetes mellitus. Clin Cardiol. 2024;47(3):e24248.
Suzuki Y, Kaneko H, Okada A, Itoh H, Matsuoka S, Fujiu K, et al. Comparison of cardiovascular outcomes between SGLT2 inhibitors in diabetes mellitus. Cardiovasc Diabetol. 2022May 18;21(1):67.
Karakasis P, Pamporis K, Stachteas P, Patoulias D, Bougioukas KI, Fragakis N. Efficacy and safety of sodium-glucose cotransporter-2 inhibitors in heart failure with mildly reduced or preserved ejection fraction: an overview of 36 systematic reviews. Heart Fail Rev. 2023;28(5):1033–51.
Lei MH, Hsu YC, Chung SL, Chen CC, Chen WC, Chen WM, et al. Assessing mortality risk in Type 2 Diabetes patients with prolonged ASCVD risk factors: the inclusive Poh-Ai predictive scoring system with CAC Score integration. Diabetol Metab Syndr. 2024May 19;16(1):104.
Mukhopadhyay P, Sanyal D, Chatterjee P, Pandit K, Ghosh S. SGLT2 inhibitors: effect on myocardial infarction and stroke in type 2 diabetes. J Clin Endocrinol Metab. 2023;108(8):2134–40.
Huang Y, Lu W, Lu H. The clinical efficacy and safety of dapagliflozin in patients with diabetic nephropathy. Diabetol Metab Syndr. 2022Mar 29;14(1):47.
Shin H, Paik JM, Everett BM, Glynn R, Wexler DJ, Patorno E. 915-P: Head-to-head comparison of dapagliflozin vs. empagliflozin—cardiovascular and safety events. Diabetes. 2024;73(Supplement_1).
Liang X, Dai J, Wang F. Sodium glucose co-transporter 2 (SGLT2) inhibitors versus dipeptidyl peptidase-4 (DPP-4) inhibitors and the risk of Atrial Fibrillation in patients with type 2 diabetes mellitus: a meta-analysis. BMC Cardiovasc Disord. 2025Jan 28;25(1):59.
Mousavi A, Shojaei S, Soleimani H, Semirani-Nezhad D, Ebrahimi P, Zafari A, et al. Safety, efficacy, and cardiovascular benefits of combination therapy with SGLT-2 inhibitors and GLP-1 receptor agonists in patients with diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials. Diabetol Metab Syndr. 2025Feb 24;17(1):68.
Neuen BL, Fletcher RA, Heath L, Perkovic A, Vaduganathan M, Badve SV, et al. Cardiovascular, kidney, and safety outcomes with GLP-1 receptor agonists alone and in combination with SGLT2 inhibitors in type 2 diabetes: a systematic review and meta-analysis. Circulation. 2024Nov 26;150(22):1781–90.
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The contributions of the authors to this manuscript are as follows: N.Z.Y.B., A.G., T.T., W.S., A.A., C.K., N.S., A.Y.E., P.R.T.R., D.S.L., H.T., A.D., and M.K. were responsible for the conceptualization of the study. A.G., T.T., W.S., A.A., C.K., N.S., A.Y.E., P.R.T.R., D.S.L., H.T., A.D., and M.K. contributed to data curation. T.T., A.A., C.K., A.Y.E., P.R.T.R., H.T., and M.K. conducted the formal analysis. N.Z.Y.B., A.G., T.T., W.S., A.A., C.K., N.S., A.Y.E., P.R.T.R., D.S.L., H.T., A.D., and M.K. were involved in the investigation. N.Z.Y.B., A.G., T.T., A.A., C.K., A.Y.E., P.R.T.R., H.T., and M.K. contributed to the methodology. N.Z.Y.B., T.T., and H.T. managed project administration. T.T., A.A., and A.Y.E. were responsible for the software. T.T., W.S., and A.D. provided the resources. N.Z.Y.B., T.T., and H.T. supervised the study. N.Z.Y.B., A.G., T.T., A.A., C.K., P.R.T.R., and M.K. validated the data. A.A., A.Y.E., and M.K. were responsible for visualization. N.Z.Y.B., A.G., T.T., A.A., C.K., and M.K. wrote the original draft, while N.Z.Y.B., A.G., T.T., A.A., C.K., N.S., A.Y.E., P.R.T.R., H.T., A.D., and M.K. reviewed and edited the manuscript.
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Benjamin, N.Z.Y., Gupta, A., Turjman, T. et al. A Comparison of Cardiovascular Benefits of Dapagliflozin and Empagliflozin in Type 2 Diabetes: A Systematic Review and Meta-analysis. SN Compr. Clin. Med. 7, 336 (2025). https://doi.org/10.1007/s42399-025-02103-y
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DOI: https://doi.org/10.1007/s42399-025-02103-y