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Subgroup analyses of CVOTs based on baseline metformin use in two previous meta-analyses, respectively, directed by Brendon L and Apostolos Tsapas have shown that SGLT-2i reduce the risk of MACE, HHF, or CV death, while GLP-1 RAs reduce MACE, cardiovascular mortality, and all-cause mortality regardless of metformin background treatment
[3] [6] Many Integrated Care Boards (ICBs) have established specific pathways for GLP-1 receptor agonist prescribing, often requiring specialist initiation and defined review points
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