Cochrane protocol outlines comparison of GLP-1 receptor agonists vs. metformin for T2DM cardiovascular prevention.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder significantly increasing the risk of cardiovascular disease (CVD), including myocardial infarction and stroke. Despite advancements in glycemic control, CVD remains a leading cause of morbidity and mortality in T2DM patients. Current standard-of-care often involves metformin as a first-line agent, but additional therapies are frequently needed to achieve optimal glycemic control and mitigate long-term complications. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as potent antihyperglycemic drugs with demonstrated cardiovascular benefits, prompting the need for a comprehensive comparison against metformin-based regimens to inform clinical practice. This review aims to address the gap in understanding the comparative efficacy and safety profiles of these two major drug classes specifically for CVD prevention.