A Danish cohort study compared new users of SGLT-2 inhibitors (SGLT-2is) and GLP-1 receptor agonists (GLP-1RAs), finding SGLT-2is linked to a slightly lower risk of diabetic foot disease, mainly neuropathy, over six years.

Why It Matters To Your Practice

• Understanding comparative risks helps guide personalized antihyperglycemic therapy.

• Diabetic foot disease remains a leading source of morbidity among patients with type 2 diabetes.

• Choice of second-line diabetes agents may influence long-term foot outcomes.

• Awareness of nuanced differences aids shared decision-making with patients.

Clinical Benefits

• SGLT-2i users had a 10% lower risk of any foot disease compared with GLP-1RA users (RR 0.90).

• Most of the benefit was due to reduced risk for peripheral neuropathy (RR 0.78).

• No significant difference was found for peripheral artery disease, foot ulcers, or amputations.

• All-cause mortality rates were similar between groups.

Managing Risks

• Risk reduction became apparent only after three years of therapy.

• Treatment discontinuation rates were high in both groups by year 3–4.

• Results may be affected by residual confounding and misclassification.

• Clinical decisions should account for individual comorbidities and preferences.

The Bottom Line

• For patients with type 2 diabetes, SGLT-2is may offer a modest advantage over GLP-1RAs in lowering the risk of foot disease, driven primarily by neuropathy reduction.

• Overall risk differences are small, and both drug classes show similar safety for other foot outcomes.

• Long-term adherence is important to realize benefits.

• Therapeutic decisions should remain individualized and holistic.