Values, preferences, and treatment burden for initiation of GLP-1 receptor agonists, SGLT-2 inhibitors, tirzepatide, and finerenone in adults with type 2 diabetes: systematic review.
Daniela C González-Cruz, Mariano Garcia-Campa, Pablo José Moreno-Peña et al.
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In 30 seconds
This systematic review synthesised quantitative and qualitative evidence on treatment values, preferences, and perceived burden among adults with type 2 diabetes considering GLP-1 receptor agonists, SGLT-2 inhibitors, tirzepatide, or finerenone. It included 34 studies involving 15 656 patients; certainty across comparisons was low or very low. Patients consistently prioritised glycaemic efficacy, cardiovascular risk reduction, and ease of administration. Oral once-daily regimens and easy-to-use once-weekly injections were generally preferred. No consistent preference emerged between SGLT-2 inhibitors and GLP-1 receptor agonists, and no studies evaluated finerenone.
Key findings
- The review included 34 studies and 15 656 patients; certainty of evidence for all comparisons was low or very low.
- Patients consistently prioritised glycaemic efficacy, cardiovascular risk reduction, and simplicity of administration.
- Oral once-daily regimens and once-weekly injectable treatments with easy-to-use devices were generally preferred.
- SGLT-2 inhibitors and GLP-1 receptor agonists were often preferred over DPP-4 inhibitors, thiazolidinediones, and insulins, but not consistently over each other.
Why it matters
Treatment preferences and perceived burden can influence whether patients are willing to initiate and continue glucose-lowering therapy. The review suggests that effectiveness and convenience are central considerations, while weight loss may be secondary. Because evidence is low or very low certainty and does not establish a clear preference between SGLT-2 inhibitors and GLP-1 receptor agonists, individual priorities remain important when discussing options.
What to keep in mind
Evidence certainty was low or very low across comparisons. No included studies evaluated finerenone, and evidence for tirzepatide came from a single study.