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Original research
Values, preferences and burden of treatment for the initiation of GLP-1 receptor agonists and SGLT-2 inhibitors in adult patients with type 2 diabetes: a systematic review
  1. José Gerardo González-González1,2,
  2. Alejandro Díaz González-Colmenero1,
  3. Juan Manuel Millán-Alanís1,
  4. Lyubov Lytvyn3,
  5. Ricardo Cesar Solis1,
  6. Reem A Mustafa4,
  7. Suetonia C Palmer5,
  8. Sheyu Li6,7,
  9. Qiukui Hao8,
  10. Neri Alejandro Alvarez-Villalobos1,
  11. Per Olav Vandvik9,
  12. René Rodríguez-Gutiérrez1,2
  1. 1Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autonoma de Nuevo Leon Facultad de Medicina, Monterrey, Nuevo León, Mexico
  2. 2Endocrinology Division, Department of Internal Medicine, Hospital Universitario Dr José Eleuterio González, Monterrey, Nuevo León, Mexico
  3. 3Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
  4. 4Internal Medicine, Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, Kansas, USA
  5. 5Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
  6. 6Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China
  7. 7Division of Population Health and Genomics, Ninewells Hospital and School of Medicine, University of Dundee, Dundee, UK
  8. 8The center of Gerontology and Geriatrics, National Center for Geriatric Clinical Research, Sichuan University, Chengdu, Sichuan, China
  9. 9Department of Medicine, Lovisenberg Diakonale Hospital, Oslo, Norway
  1. Correspondence to Dr René Rodríguez-Gutiérrez; rodriguezgutierrez.rene{at}


Objectives Assess values, preferences and burden of treatment that patients with type 2 diabetes consider when initiating glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium-glucose cotransporter-2 inhibitors (SGLT-2i) compared with other glucose-lowering options.

Methods Paired reviewers independently included studies reporting quantitative or qualitative methods to assess values, preferences and burden of treatment reported by patients with type 2 diabetes regarding the initiation of GLP-1 RA or SGLT-2i over other alternatives. A systematic search in MEDLINE, Scopus, EMBASE, Web of Science and Cochrane Central Register of Controlled Trials from inception until May 2020 was performed by an experienced librarian. Risk of bias was assessed with a specifically designed tool for values and preferences studies.

Results 17 studies (7296 patients) proved eligible. Studies fulfilling criteria for SGLT-2i were not identified. Five studies (2662 patients) evaluated preferences for GLP-1 RA compared with other glucose-lowering medications. 12 studies (4634 patients) evaluated preferences between, at least, two kinds of GLP-1 RA or their injection devices based on the following attributes: efficacy, dose, application frequency, device characteristics. Among studies comparing GLP-1 RA to other glucose-lowering medications, some preferences were observed for dypeptil peptidase-4 inhibitors compared with once daily liraglutide. Comparing different attributes of GLP-1 RA drugs and devices, cardiovascular risk reduction, glucose lowering potential, once weekly and simple administered regimens were the most preferred.

Conclusions As no evidence for preferences on SGLT-2i was available, only preferences for GLP-1 RA were assessed; however, evidence is still limited for the latter. Studies comparing preferences for GLP1-RA to other glucose-lowering alternatives only included twice daily or once daily injection regimens of GLP-1 RA drugs. According to our findings, once weekly alternatives are widely preferred than the formers. The extent to which patients with type 2 diabetes value reduced adverse cardiovascular and kidney outcomes, weighed benefits against harms and burden of treatment is limited and with very low certainty.

PROSPERO registration number CRD42020159284.

  • diabetes & endocrinology
  • general endocrinology
  • general diabetes

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  • Contributors Conceiving of the research idea: JGG-G, RR-G, LL, RAM, SP, SL, QH and PV; First draft of the research protocol: JGG-G, ADG-C, JMM-A, RCS, NA-V, RR-G; Final version of the research protocol: all authors; Search strategy design: NA-V; Study selection process: JGG-G, ADG-C, JMM-A and RCS; Data extraction process: JGG-G, ADG-C, JMM-A and RCS; Data synthesis: JGG-G, ADG-C, JMM-A and RCS; First draft of the manuscript: JGG-G, ADG-C, JMM-A, RCS and RR-G; Final version of the manuscript: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests All authors have completed the ICMJE uniform disclosure form at and declare: JGG-G, ADG-C, JMM-A, LL, RCS, RAM, SP, SL, QH, NA-V, PV, RR-G: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years. SL was supported by grants from the National Natural Science Foundation of China (grant number 21534008), Sichuan Science and Technology Program (grant number 2019YFH0150), and 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (grant number ZYGD18022 and 2020HXF011). But none of the grant contributes to this work.

  • Patient and public involvement statement The paper informs a Rapid Recommendation on the use of SGLT-2 inhibitors and GLP-1 receptor agonists that will be released on a digital platform ( and made available to organisations to adapt for their own materials and purposes.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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