Patients with diabetes continued to exhibit a high risk for cardiovascular and renal
events despite achieving satisfactory glycemic, blood pressure and lipid targets. Studies evaluating
new diabetes medications focused on cardiovascular events, largely overlooking heart failure (HF).
The latter has recently been recognised as a major cause of morbidity and mortality in patients with
diabetes mellitus. There had been an unmet need for drugs with cardiovascular (including HF) and
renal protection, with an expectation that an ideal diabetic drug should improve these endpoints.
Moreover, an ideal drug should have weight reducing benefits. Recently published outcome trials
have shown that sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 receptor
agonists (GLP-1RAs) can reduce cardiovascular and renal events, together with statistically
significant weight reduction. As a result, many recently published international guidelines have recommended
SGLT2 inhibitors and GLP-1RAs in patients with diabetes and pre-existing cardiovascular
disease (CVD). In this review, we will critically analyse the efficacy and cardiovascular (CV)
safety of SGLT2 inhibitors, based on the available literature to help position them in the clinical decision