Nezam El-Tayebat Fact CheckA scientific assessment of the “نظام الطيبات” nutrition system
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False Scientifically refuted Certainty of evidence: high provisional C-ODD-06

Glucose-lowering drugs are net harmful and belong among the 'forbidden' items; dapagliflozin (Forxiga) is among the 'dirtiest' drugs and kills the brain; leg amputations happen only to people taking diabetes drugs and insulin.

Safety note: Do not stop prescribed diabetes, heart or kidney medication because of this claim; stopping SGLT2 inhibitors or GLP-1 receptor agonists in people with heart failure, kidney disease or cardiovascular disease removes a proven protection. Discuss concerns with the treating physician.
In short: This claim is false. Large randomised trials show that dapagliflozin and several other diabetes drugs reduce deaths, heart failure and kidney failure; there is no evidence that dapagliflozin kills the brain, and leg amputations also occur in people who never took diabetes drugs.
Conclusion: False: dapagliflozin and several other diabetes drugs reduce deaths, heart failure and kidney failure in large trials; there is no evidence that dapagliflozin damages the brain, and amputations also occur in people who never took diabetes drugs.
  1. Original statement
  2. Scientific assessment
  3. Scientific evidence in detail
  4. In plain language
  5. Studies on this claim
  6. Regional context
  7. What applies in my country?
  8. References

Original statement

الفورسيجا ده من اقذر من اقذر ما يمكن يعني انا ما شفتش ادويه اخذر منه غير الانسولين

verbatim according to source. Translation by the project; the Arabic wording is authoritative.

Translation

Glucose-lowering drugs are net harmful and belong among the 'forbidden' items; dapagliflozin (Forxiga) is among the 'dirtiest' drugs and kills the brain; leg amputations happen only to people taking diabetes drugs and insulin.

Origin

Source status
Video transcript (own words)
Attribution
Elawady (machine transcript)
Video
الغيبوبات السكرية ؟! (Open source)
Published
30 April 2025
Timestamp
0:10:28 (location in the original video’s automatic YouTube caption track; confirms where the words occur, not who speaks)
Attribution uncertainty
Archive transcript (YouTube CC or AI-generated); no timestamps; 'published' is the date listed by the archive and may be the upload date. Live-stream transcripts can contain viewer comments read aloud; the quoted passage was checked in context to be spoken by Elawady.
Claimed mechanism

Drugs block normal metabolism; harm outweighs benefit.

Claimed health effect

Brain damage, amputation, death

Population concerned

People with diabetes

Geographic restriction by Elawady

none found

Diverging source versions

Source status
Video transcript (own words)
Attribution
Elawady (machine transcript)
Video
Dr Diaa Al Awady د ضياء العوضي is live! الموت المفاجيء (Open source)
Published
14 July 2025
Timestamp
not available (transcript has no timings)
Attribution uncertainty
Archive transcript (YouTube CC or AI-generated); no timestamps; 'published' is the date listed by the archive and may be the upload date. Live-stream transcripts can contain viewer comments read aloud; the quoted passage was checked in context to be spoken by Elawady.
Source status
Archive editors
Attribution
Archive editors (not Elawady)
Origin
https://eltayebat.com/rule/oral-diabetes-drugs/
Attribution uncertainty
Editorial narrative and study selection written by the archive operators.

يسمع طب ولا غير اللي هيوطي السكر هيتفشخ اللي هياخد انسولين هيتفشخ اللي هياخد دوا جالفس هيتفشخ اللي هياخد فورسيجا هيتفشخ اللي هياخد مونجارو هيتفشخ اللي هياخداني اسمه ايه اللي شبه المونجارو ده اوزمبيك هيتفشخ خلاص اللي [أصوات

Anyone who lowers blood sugar will be harmed: anyone taking insulin, Galvus (vildagliptin), Forxiga (dapagliflozin), Mounjaro (tirzepatide) or Ozempic (semaglutide) will be badly harmed.

Source status
Video transcript (own words)
Attribution
Elawady (machine transcript)
Video
بدأت قناة ＂Dr Diaa Al Awady د ضياء العوضي＂ بثًا مباشرًا ذكري يوم ميلادي 😂😂❤️❤️❤️ (Open source)
Published
26 March 2026
Timestamp
1:16:53 (location in the original video’s automatic YouTube caption track; confirms where the words occur, not who speaks)
Attribution uncertainty
Archive transcript (YouTube CC or AI-generated); no timestamps; 'published' is the date listed by the archive and may be the upload date. Live-stream transcripts can contain viewer comments read aloud; the quoted passage was checked in context to be spoken by Elawady.

لن أوقف أدويتي الموصوفة بسبب هذا الموقع

altayybat requires users to confirm on entry that they will not stop prescribed medicines because of the site.

Source status
Third-party site (unofficial)
Attribution
Third-party site (unofficial; lowest attribution level)
Origin
https://altayybat.com/ar/
Attribution uncertainty
altayybat.com states on its pages that it is educational only and not affiliated with Dr. Diaa Elawady. Lowest attribution level; page fetched 2026-10-25.

المضادات الحيوية وأدوية الضغط والسكري والإنسولين ممنوعة|ويجب استشارة طبيبك الخاص وتحت اشرافه

CONFLICT: mytayibat lists antibiotics, blood-pressure and diabetes drugs and insulin as 'forbidden', adding 'consult your own doctor and under his supervision'.

Source status
Third-party site (unofficial)
Attribution
Third-party site (unofficial; lowest attribution level)
Origin
https://mytayibat.com/forbidden
Attribution uncertainty
mytayibat.com is an unofficial third-party site in the sense that it is neither the eltayebat.com archive nor Elawady's own words. Its footer describes it as 'المنصة الرسمية التعليمية لنظام الطيبات' ('the official educational platform of the Tayebat system'), and its pages refer to it as 'the official platform'. This self-description could not be verified: no evidence was found that the site is authorised by Dr. Diaa Elawady's heirs or by the eltayebat.com archive. By contrast, altayybat.com states that it is not affiliated with Dr. Diaa Elawady. Lowest attribution level; page fetched 2026-10-25. original_ar joins two passages of the page with '|'.

Scientific assessment

False – The statement contradicts the robust evidence.

Certainty of evidence: high – Further research is very unlikely to change the assessment.

1. What was claimed?

Diabetes drugs are net harmful; Forxiga kills the brain; amputations are caused by the drugs.

2. What is demonstrably correct?

All drugs have side effects (see C-ODD-05); canagliflozin was associated with toe/metatarsal amputations in CANVAS (6.3 vs 3.4 per 1,000 patient-years; HR 1.97) (A-ODD-09).

3. What is wrong or exaggerated?

The same CANVAS trial showed a net cardiovascular benefit (HR 0.86), fewer serious adverse events than placebo (104.3 vs 120.0 per 1,000 patient-years), and amputations also in the placebo group (3.4 per 1,000 patient-years), which contradicts both 'net harmful' and 'amputations happen only to people taking diabetes drugs' (A-ODD-09). Dapagliflozin reduced cardiovascular death or worsening heart failure (HR 0.74) and all-cause death (HR 0.83) in DAPA-HF (I-ODD-04) and reduced death (HR 0.69) and kidney endpoints in DAPA-CKD, which was stopped early for efficacy (I-ODD-03). Empagliflozin reduced all-cause death by 32% (I-ODD-02); canagliflozin reduced kidney failure by 32% (I-ODD-05); liraglutide reduced death (HR 0.85) (I-ODD-06); semaglutide reduced major cardiovascular events (HR 0.74) (I-ODD-07). Higher glucose exposure is associated with more amputations and complications without threshold (I-INS-04). No evidence was found that dapagliflozin damages the brain.

4. What remains unclear?

How often the adverse effects of individual drugs occur in Egyptian practice was not reviewed. Whether the amputation signal seen with canagliflozin in CANVAS (A-ODD-09) applies to other drugs of the class was not reviewed here.

5. Which studies support it?

None for the claim as stated. A-ODD-09 documents an amputation signal with one drug but also net benefit and amputations on placebo.

6. Which studies contradict it?

I-ODD-107 (816-trial NMA: all-cause death OR 0.88 for SGLT2i and GLP-1 RA, high certainty), I-ODD-106 (13 blinded SGLT2i trials: kidney progression RR 0.63, CV death RR 0.86; about 26 events avoided vs 2 caused per 1,000 patient-years), I-ODD-105 (DECLARE, dapagliflozin), I-ODD-02, I-ODD-03, I-ODD-04, I-ODD-05, I-ODD-06, I-ODD-07, I-ODD-112, I-ODD-01, I-INS-04, I-ODD-17, I-ODD-126 (NICE 2026), I-ODD-110 (no RCT signal of dementia with SGLT2i), I-ODD-111 (157 of 290 amputees had no diabetes), A-ODD-09.

7. What applies to Germany and Europe?

European (EASD) and German (DDG) guidance follow the same evidence base as the ADA/EASD consensus: individualised HbA1c targets, insulin as mandatory therapy in type 1 diabetes, and SGLT2 inhibitors/GLP-1 receptor agonists for people with cardiovascular or kidney disease. No country-specific difference changes the assessment.

8. What is known about Egypt?

Egypt has one of the highest diabetes prevalences in the region; the same drug classes and insulins are used. Access barriers and cost may make advice to stop medication attractive, which increases the practical risk of this claim. No Egypt-specific evidence changes the assessment.

9. What practical conclusion is appropriate?

Several diabetes drug classes have proven benefits that outweigh their risks in defined patient groups; decisions should be individual and made with a physician.

Assessment details

Rationale for certainty of evidence

Multiple large, double-blind RCTs show reductions in death, heart failure and kidney failure (empagliflozin, dapagliflozin, canagliflozin, liraglutide, semaglutide) and metformin reduced mortality in UKPDS 34. Amputations are caused mainly by diabetic neuropathy and vascular disease driven by hyperglycaemia, which predates modern drugs.

Source quality

Own words plus archive placement of drugs in the 'forbidden' section.

Regional transferability

Universal.

Individual exceptions

Individual drugs may be unsuitable for individual patients (e.g. SGLT2 in type 1 diabetes or ketosis-prone patients).

Regional scope of the claim
general (biological/medical)
Last reviewed
26 October 2026 provisional

Scientific evidence in detail

Scientifically refuted – High-quality evidence shows the opposite, or the claim contradicts well-established physiology.

Research question: Are glucose-lowering drugs (in particular dapagliflozin) net harmful, do they damage the brain, and do leg amputations occur only in people taking diabetes drugs or insulin?

Research question in detail (PICO)
Population
People with type 2 diabetes (and heart failure/CKD)
Intervention or exposure
Glucose-lowering drugs, especially SGLT2 inhibitors (dapagliflozin) and GLP-1 RAs
Comparison
Placebo/standard care; people without diabetes treatment
Geographic scope
universal biology
Outcomes
  • All-cause mortality
  • Kidney failure, heart failure
  • Dementia/cognitive outcomes
  • Lower-limb amputation

Study results as reported by the authors. Our assessment follows below.

What speaks for the claim?

  • Canagliflozin heart and kidney trials (CANVAS)

    Neal B et al.. N Engl J Med 2017 · PMID 28605608 · DOI 10.1056/NEJMoa1611925 Randomised controlled trialfull text, structured risk-of-bias assessment

    CANVAS: canagliflozin increased toe/metatarsal amputations.

    Actual result
    6.3 vs 3.4 per 1,000 patient-years; HR 1.97.
    Methodological quality
    high (RCT) for this outcome, but not replicated in 12 other trials (I-ODD-106)
    Relevance
    indirect - one drug, not 'only' drug users
    Limitations
    Signal not replicated; same trial showed net benefit.

    Original publication

  • Very aggressive blood sugar lowering in high-risk type 2 diabetes

    Action to Control Cardiovascular Risk in Diabetes Study Group; Gerstein HC et al.. N Engl J Med 2008 · PMID 18539917 · DOI 10.1056/NEJMoa0802743 Randomised controlled trialfull text checked

    ACCORD: very intensive glucose lowering increased mortality.

    Actual result
    HR 1.22 (1.01-1.46).
    Methodological quality
    high
    Relevance
    indirect - harm of aggressive targets, not of the drugs as such
    Limitations
    Older drug strategies; not applicable to SGLT2i/GLP-1 RA.

    Original publication

What speaks against the claim?

What does the overall evidence say?

Editorial assessment based on the studies above – not itself a study result.

Which position is better supported?

Several glucose-lowering drug classes, including dapagliflozin, reduce death, heart failure and kidney failure in large blinded trials. No randomised evidence shows that dapagliflozin damages the brain (dementia OR 1.20, 0.67-2.17, imprecise). More than half of leg amputees in a population registry had no diabetes; in diabetes, amputations are driven by vascular disease and neuropathy linked to high glucose.

Why some studies weigh more

Large blinded RCTs and their meta-analyses, plus 2026 guidelines, outweigh the isolated CANVAS amputation signal and ACCORD (which concerned aggressive targets with older drugs).

Is a causal relationship established? Yes, established Benefits are established by RCTs; brain harm and the 'only drug users' amputation statement have no supporting evidence.

Remaining uncertainty

Long-term cognitive effects of SGLT2i (imprecise RCT data).

Justified conclusion

The claim is false.

Why do studies seem to disagree?

ACCORD's excess mortality and the mortality reductions with SGLT2i/GLP-1 RAs concern different interventions (aggressive HbA1c targets with insulin/sulfonylureas vs specific drugs at usual targets). The CANVAS amputation signal differs from 12 other SGLT2i trials (heterogeneity p=0.0007).

Does this depend on the country?
General biological effects
Drug pharmacology and physiology are universal.
Eating habits
Prolonged fasting, Ramadan fasting and very-low-carbohydrate eating change the risk of hypoglycaemia and ketoacidosis with some drugs; relevant in Egypt and among Muslims in Europe.
Origin of the food
Not applicable.
Contaminants
Not applicable.
National production conditions
Not applicable (same active substances; generics widely used in Egypt).
Legal rules
Drug labels and warnings are set by FDA/EMA and national regulators; Egyptian labelling not reviewed.
Actual monitoring data
No Egypt-specific pharmacovigilance data were found for this outcome.

A regional difference that changes the conclusion is not supported by robust data.

Statistical re-check
  • Benefit-harm balance per 1,000 patient-years – About 26 events avoided vs about 2 caused (CKD with diabetes). recalculated
  • Share of amputees without diabetes – 157 of 290 (54%). recalculated
  • Precision of dementia OR – OR 1.20 (0.67-2.17), SE(log) 0.30: imprecise, no signal. recalculated
Certainty of the overall evidence (GRADE, simplified)
Main outcome
All-cause mortality with SGLT2i/GLP-1 RA vs placebo
Starting level
high (randomised trials)
Result
high

Simplified assessment by a single reviewer, following the GRADE approach; not a formal GRADE panel. GRADE rates the body of evidence for one outcome, not individual studies.

Clinical guidelines and official statements checked
  • ADA: 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2026 (Diabetes Care 2026;49 Suppl 1) (2026) · Original publication
    In type 2 diabetes with ASCVD, heart failure or CKD, use SGLT2i and/or GLP-1 RA with proven benefit irrespective of A1C (recs. 9.7, 9.8, 9.10).
  • NICE: Type 2 diabetes in adults: management (NG28), last updated 18 February 2026 (2026) · Original publication
    Offer modified-release metformin and an SGLT-2 inhibitor to adults with type 2 diabetes without relevant comorbidity (rec. 1.13.1, 2026); benefits outweigh risks for most people.
Search strategy

Documented literature searches for this review (search strings in the original database syntax).

DatabaseDateSearchLooking forHitsIncluded
Europe PMC26 October 2026(TITLE:"SGLT2" OR TITLE:"sodium-glucose cotransporter 2" OR TITLE:"dapagliflozin" OR TITLE:"SGLT-2") AND (TITLE:dementia OR TITLE:cognitive OR TITLE:stroke OR TITLE:brain) AND (cohort OR "meta-analysis" OR trial)both directions122
PubMed26 October 2026(SGLT2[tiab] OR "sodium-glucose cotransporter-2"[tiab] OR SGLT-2[tiab]) AND dementia[ti] AND (BMJ[ta] OR meta-analysis[pt])contradicting evidence20
Europe PMC26 October 2026(TITLE:"amputation") AND (SGLT2 OR canagliflozin OR "glucose-lowering" OR insulin) AND ("meta-analysis" OR cohort)supporting evidence228
PubMed26 October 2026(dapagliflozin[ti] OR "SGLT2 inhibitor*"[ti]) AND (stroke[ti] OR "cerebral"[ti] OR "neurological"[ti] OR "cognitive"[ti]) AND (adverse[tiab] OR harm[tiab] OR risk[tiab])supporting evidence30
Europe PMC26 October 2026(dapagliflozin) AND ("all-cause mortality" OR "death from any cause") AND ("heart failure" OR "chronic kidney disease") AND (randomized OR randomised) AND PUB_TYPE:"Randomized Controlled Trial"contradicting evidence162
Europe PMC26 October 2026(Egypt OR Egyptian) AND (SGLT2 OR dapagliflozin OR empagliflozin OR "GLP-1" OR metformin OR insulin) AND ("adverse" OR "outcomes" OR "ketoacidosis" OR amputation)both directions14938
NICE NG28 (2026)26 October 2026Fetched https://www.nice.org.uk/guidance/ng28/chapter/Initial-medicines; chapter Initial medicinesguidelines1
ADA Standards of Care 2026, Section 9 (PubMed Central)26 October 2026Fetched https://pmc.ncbi.nlm.nih.gov/articles/PMC12690185/; recs. 9.7-9.10. The diabetesjournals.org DOI landing pages returned HTTP 403; the identical article was read in PubMed Central.guidelines1

Open questions

Dedicated long-term cognitive trials of SGLT2 inhibitors.

How deeply was this checked?

18 linked studies: 7 checked in full text (4 of them with a structured risk-of-bias assessment), 11 on the basis of the abstract, 0 bibliographically only. No formal assessment with two independent reviewers and no independent human expert review has taken place yet.

Last scientific review: 26 October 2026

History of the verdict
  1. 25 October 2026 · Phase 1 · Initial assessment: False (high)
  2. 26 October 2026 · Phase 4 (systematic evidence review) · Re-examined with extended evidence; verdict unchanged: False (high)
    New high-quality evidence (I-ODD-106, I-ODD-107, I-ODD-112, NICE 2026) strengthens the existing verdict; amputation and brain components are now addressed with specific evidence (I-ODD-111, I-ODD-110).
    New sources: I-ODD-105 I-ODD-106 I-ODD-107 I-ODD-110 I-ODD-111 I-ODD-112 I-ODD-126

In plain language

The videos call Forxiga one of the dirtiest drugs. Yet large trials with thousands of patients showed that Forxiga and similar drugs reduce deaths, heart failure and kidney failure. Amputations in diabetes are mainly caused by nerve and blood vessel damage from long-term high blood sugar, not by medicines in general.

Studies on this claim

Studies supporting the claim (0)

No studies in this group.

Studies contradicting or limiting the claim (17)

  • Metformin in overweight type 2 diabetes (UKPDS 34)

    UKPDS Group. Lancet 1998 · PMID 9742977
    Randomised controlled trialindependent cross-checkabstract checked★ key study

    Metformin reduced deaths from any cause by about a third over 10 years.

    Does the study support the specific claim? No · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    Intensive control with metformin in overweight type 2 diabetes

    How was the study done?

    RCT within UKPDS (UKPDS 34)

    How many people, animals or samples were studied?

    753 (main comparison); Overweight newly diagnosed type 2 diabetes, mean age 53

    What was actually found?

    Mortality -36%.

    How large was the observed effect?

    RR reduction 36% (9-55)

    What do the results mean in everyday life?

    Metformin is protective.

    What are the study's limitations?

    Small arms; Open-label; Conflicting supplementary result

    What does it say about Elawady's specific claim?

    Contradicts C-ODD-01, C-ODD-06; supports C-INS-11.

    Do the results apply to Germany and Europe?

    UK.

    What can explicitly not be concluded from this study?

    Effects in non-overweight patients.

    Scientific details →

  • Empagliflozin heart trial

    Zinman B et al.. N Engl J Med 2015 · PMID 26378978 · DOI 10.1056/NEJMoa1504720
    Randomised controlled trialindependent cross-checkabstract checked★ key study

    Deaths fell from 8.3% to 5.7% over about 3 years.

    Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    CV outcomes of empagliflozin in type 2 diabetes at high CV risk

    How was the study done?

    Double-blind placebo-controlled RCT (EMPA-REG OUTCOME)

    How many people, animals or samples were studied?

    7,020; Type 2 diabetes with high CV risk

    What was actually found?

    Primary 10.

    How large was the observed effect?

    HR 0.86; death -32%

    What do the results mean in everyday life?

    This drug class protects heart and/or kidneys in the studied patients.

    What are the study's limitations?

    Industry funded; Selected high-risk population

    What does it say about Elawady's specific claim?

    Contradicts C-ODD-06; context for C-ODD-02, C-ODD-08.

    Do the results apply to Germany and Europe?

    Multinational trial including European sites or directly applicable to EU practice.

    What can explicitly not be concluded from this study?

    Benefit in low-risk people; absence of side effects.

    Scientific details →

  • Dapagliflozin (Forxiga) in kidney disease

    Heerspink HJL et al.. N Engl J Med 2020 · PMID 32970396 · DOI 10.1056/NEJMoa2024816
    Randomised controlled trialindependent cross-checkfull text, structured risk-of-bias assessment★ key study

    Forxiga reduced kidney failure and deaths; the trial was stopped early because the benefit was clear.

    Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    Dapagliflozin in CKD with/without diabetes

    How was the study done?

    Double-blind placebo-controlled RCT (DAPA-CKD)

    How many people, animals or samples were studied?

    4,304; CKD (eGFR 25-75, albuminuria)

    What was actually found?

    Kidney failure, kidney decline or kidney/heart death: 9.2% with dapagliflozin vs 14.5% with placebo; deaths 4.7% vs 6.8%. Amputations 1.6% vs 1.8%; no ketoacidosis cases with dapagliflozin (2 with placebo).

    How large was the observed effect?

    HR 0.61; death HR 0.69

    What do the results mean in everyday life?

    This drug class protects heart and/or kidneys in the studied patients.

    What are the study's limitations?

    Industry funded; stopped early for benefit (can overstate effect); selected high-risk CKD population; type 1 diabetes excluded; median 2.4 years follow-up.

    What does it say about Elawady's specific claim?

    Contradicts C-ODD-06 (Forxiga 'kills'); context for C-ODD-02.

    Do the results apply to Germany and Europe?

    Multinational trial including European sites or directly applicable to EU practice.

    What can explicitly not be concluded from this study?

    Benefit in low-risk people; absence of side effects.

    Scientific details →

  • Dapagliflozin in heart failure

    McMurray JJV et al.. N Engl J Med 2019 · PMID 31535829 · DOI 10.1056/NEJMoa1911303
    Randomised controlled trialindependent cross-checkabstract checked★ key study

    Fewer heart failure worsenings and deaths with Forxiga.

    Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    Dapagliflozin in heart failure with reduced EF

    How was the study done?

    Double-blind placebo-controlled RCT (DAPA-HF)

    How many people, animals or samples were studied?

    4,744; HFrEF NYHA II-IV, EF <=40%, with/without diabetes

    What was actually found?

    Primary 16.

    How large was the observed effect?

    HR 0.74; death HR 0.83

    What do the results mean in everyday life?

    This drug class protects heart and/or kidneys in the studied patients.

    What are the study's limitations?

    Industry funded; Selected high-risk population

    What does it say about Elawady's specific claim?

    Contradicts C-ODD-06.

    Do the results apply to Germany and Europe?

    Multinational trial including European sites or directly applicable to EU practice.

    What can explicitly not be concluded from this study?

    Benefit in low-risk people; absence of side effects.

    Scientific details →

  • Canagliflozin in diabetic kidney disease

    Perkovic V et al.. N Engl J Med 2019 · PMID 30990260 · DOI 10.1056/NEJMoa1811744
    Randomised controlled trialindependent cross-checkfull text, structured risk-of-bias assessment★ key study

    Kidney failure and heart problems fell by about a third; amputations and fractures were not increased, but rare ketoacidosis was more common (11 vs 1 cases).

    Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    Canagliflozin and renal outcomes in type 2 diabetes with nephropathy

    How was the study done?

    Double-blind placebo-controlled RCT (CREDENCE)

    How many people, animals or samples were studied?

    4,401; Type 2 diabetes with albuminuric CKD

    What was actually found?

    Primary kidney/heart outcome 43.2 vs 61.2 per 1000 patient-years (30% lower); amputation 12.3 vs 11.2 per 1000 patient-years (not significant); diabetic ketoacidosis 2.2 vs 0.2 per 1000 patient-years.

    How large was the observed effect?

    HR 0.70

    What do the results mean in everyday life?

    This drug class protects heart and/or kidneys in the studied patients.

    What are the study's limitations?

    Industry funded; stopped early for benefit; selected high-risk population; foot checks added during the trial may have lowered amputation risk; rare harms imprecise.

    What does it say about Elawady's specific claim?

    Contradicts C-ODD-06; limits amputation/fracture signals in C-ODD-05.

    Do the results apply to Germany and Europe?

    Multinational trial including European sites or directly applicable to EU practice.

    What can explicitly not be concluded from this study?

    Benefit in low-risk people; absence of side effects (ketoacidosis was increased); amputation safety in routine care without foot surveillance.

    Scientific details →

  • Liraglutide heart trial

    Marso SP et al.. N Engl J Med 2016 · PMID 27295427 · DOI 10.1056/NEJMoa1603827
    Randomised controlled trialindependent cross-checkfull text, structured risk-of-bias assessment★ key study

    Fewer heart deaths and deaths overall; pancreatitis not increased, but more gallstone disease and a small, non-significant excess of pancreatic cancer.

    Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    CV outcomes of liraglutide

    How was the study done?

    Double-blind placebo-controlled RCT (LEADER)

    How many people, animals or samples were studied?

    9,340; Type 2 diabetes with high CV risk

    What was actually found?

    Heart attack, stroke or heart death 13.0% vs 14.9%; deaths 8.2% vs 9.6%; acute pancreatitis 18 vs 23 patients; pancreatic cancer 13 vs 5 (not significant); gallstone disease 3.1% vs 1.9%.

    How large was the observed effect?

    HR 0.87; death HR 0.85

    What do the results mean in everyday life?

    This drug class protects heart and/or kidneys in the studied patients.

    What are the study's limitations?

    Industry funded with sponsor co-analysis; high-risk population; safety outcomes not powered and not adjusted for multiple testing; 3.5-5 years follow-up.

    What does it say about Elawady's specific claim?

    Contradicts C-ODD-06; limits C-ODD-04.

    Do the results apply to Germany and Europe?

    Multinational trial including European sites or directly applicable to EU practice.

    What can explicitly not be concluded from this study?

    Benefit in low-risk people; that pancreatic cancer risk is absent or present (too few cases); anything about pancreatic cysts.

    Scientific details →

  • Semaglutide heart safety trial

    Marso SP et al.. N Engl J Med 2016 · PMID 27633186 · DOI 10.1056/NEJMoa1607141
    Randomised controlled trialindependent cross-checkabstract checked★ key study

    Fewer heart attacks/strokes, but more diabetic eye complications and stomach side effects.

    Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    CV safety of semaglutide

    How was the study done?

    Double-blind placebo-controlled RCT (SUSTAIN-6)

    How many people, animals or samples were studied?

    3,297; Type 2 diabetes, 83% with CVD/CKD

    What was actually found?

    Primary 6.

    How large was the observed effect?

    HR 0.74

    What do the results mean in everyday life?

    This drug class protects heart and/or kidneys in the studied patients.

    What are the study's limitations?

    Industry funded; Selected high-risk population

    What does it say about Elawady's specific claim?

    Contradicts C-ODD-06; GI and retinopathy harms relevant to C-ODD-05.

    Do the results apply to Germany and Europe?

    Multinational trial including European sites or directly applicable to EU practice.

    What can explicitly not be concluded from this study?

    Benefit in low-risk people; absence of side effects.

    Scientific details →

  • How much long-term blood sugar matters (UKPDS 35)

    Stratton IM et al.. BMJ 2000 · PMID 10938048 · DOI 10.1136/bmj.321.7258.405
    Cohort studyindependent cross-checkabstract checked★ key study

    Each 1% lower HbA1c was linked to 21% fewer diabetes deaths and 37% fewer eye/kidney complications.

    Does the study support the specific claim? No · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    Relation of glycaemia over time to complications

    How was the study done?

    Prospective observational analysis within UKPDS (UKPDS 35)

    How many people, animals or samples were studied?

    4,585 (3,642 for RR); UKPDS patients (white, Asian Indian, Afro-Caribbean)

    What was actually found?

    Graded risk with HbA1c, no threshold.

    How large was the observed effect?

    -21% per 1% HbA1c

    What do the results mean in everyday life?

    High sugar damages the body.

    What are the study's limitations?

    Observational

    What does it say about Elawady's specific claim?

    Contradicts C-DIAB-01, C-DIAB-02, C-ODD-06 (hyperglycaemia causes complications incl. amputation).

    Do the results apply to Germany and Europe?

    UK.

    What can explicitly not be concluded from this study?

    That pushing HbA1c to normal is always safe.

    Scientific details →

  • ADA/EASD consensus 2022

    Davies MJ et al.. Diabetes Care 2022 · PMID 36148880 · DOI 10.2337/dci22-0034
    Guideline / position statementindependent cross-checkabstract checked

    Weight management plus heart- and kidney-protective drugs are central to type 2 diabetes care.

    Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    Management of hyperglycaemia in type 2 diabetes

    How was the study done?

    ADA/EASD consensus report based on systematic examination of publications since 2018

    How many people, animals or samples were studied?

    not applicable; Adults with type 2 diabetes

    What was actually found?

    Cardiorenal protection and weight focus.

    How large was the observed effect?

    not applicable

    What do the results mean in everyday life?

    Guideline direction.

    What are the study's limitations?

    Abstract only read

    What does it say about Elawady's specific claim?

    Contradicts C-ODD-06; supports C-INS-11.

    Do the results apply to Germany and Europe?

    EASD co-authored; directly applicable to EU.

    What can explicitly not be concluded from this study?

    Not applicable.

    Scientific details →

  • Canagliflozin heart and kidney trials (CANVAS)

    Neal B et al.. N Engl J Med 2017 · PMID 28605608 · DOI 10.1056/NEJMoa1611925
    Randomised controlled trialcited by the Tayebat archivefull text, structured risk-of-bias assessment★ key study

    Fewer heart attacks, strokes and heart deaths (-14%), but more toe/foot amputations.

    Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    CV, renal and safety outcomes of canagliflozin

    How was the study done?

    Integrated analysis of two double-blind RCTs (CANVAS Program)

    How many people, animals or samples were studied?

    10,142; Type 2 diabetes with high CV risk, mean age 63.3

    What was actually found?

    14% fewer heart attacks, strokes or heart deaths; about twice as many amputations (6.3 vs 3.4 per 1,000 patient-years), mostly toes; more fractures and genital infections.

    How large was the observed effect?

    HR 0.86 / 1.97

    What do the results mean in everyday life?

    Both benefits and risks; foot care matters.

    What are the study's limitations?

    Funded and co-analysed by the manufacturer; two trials combined; many secondary results only exploratory.

    What does it say about Elawady's specific claim?

    Supports C-ODD-05 (signal); contradicts C-ODD-06 (benefit).

    Do the results apply to Germany and Europe?

    Multinational/US/UK data; transferable to EU practice.

    What can explicitly not be concluded from this study?

    That SGLT2 inhibitors are net harmful.

    Scientific details →

  • Forxiga in 17,160 people: fewer heart-failure admissions, rare ketoacidosis

    Wiviott SD et al.. N Engl J Med 2019 · PMID 30415602 · DOI 10.1056/NEJMoa1812389
    Randomised controlled trialindependent cross-checkabstract checked★ key study

    HF hospitalisation HR 0.73; renal events HR 0.76; DKA 0.3% vs 0.1%.

    Fewer HF hospitalisations and renal events; no excess death; no brain-related harm reported.

    Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    Test cardiovascular safety and benefit of dapagliflozin.

    How was the study done?

    Blinded RCT vs placebo.

    How many people, animals or samples were studied?

    17,160 adults with type 2 diabetes.

    What was actually found?

    No change in heart attacks/strokes; fewer heart-failure hospitalisations and kidney events; slightly more DKA and genital infections.

    How large was the observed effect?

    HHF HR 0.73 (0.61-0.88); DKA +0.2 percentage points.

    What do the results mean in everyday life?

    The drug helps the heart and kidneys; a rare ketoacidosis risk requires precautions.

    What are the study's limitations?

    Industry-funded; few DKA events.

    What does it say about Elawady's specific claim?

    Supports the DKA part (C-ODD-02); contradicts 'dirtiest drug' and net harm (C-ODD-06).

    Do the results apply to Germany and Europe?

    High.

    What can explicitly not be concluded from this study?

    Risk during prolonged fasting.

    Scientific details →

  • 13 large trials: SGLT2 drugs protect kidneys and heart; ketoacidosis rare

    Nuffield Department of Population Health Renal Studies Group; SMART-C Consortium. Lancet 2022 · PMID 36351458 · DOI 10.1016/S0140-6736(22)02074-8
    Meta-analysisindependent cross-checkfull text checked★ key study

    Kidney progression -37%, CV death -14%; DKA risk doubled from about 0.2 per 1,000 patient-years.

    Large absolute benefits outweigh DKA and amputation.

    Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    Pool all large placebo-controlled SGLT2 inhibitor trials.

    How was the study done?

    Collaborative meta-analysis of 13 blinded RCTs.

    How many people, animals or samples were studied?

    90,409 participants.

    What was actually found?

    Clear kidney and heart benefits; DKA doubled but rare; amputation signal mainly from one trial.

    How large was the observed effect?

    RR 0.63 kidney; RR 0.86 CV death; DKA RR 2.12.

    What do the results mean in everyday life?

    For 1,000 people with diabetes and kidney disease treated for a year, about 26 serious events are avoided and about 2 caused.

    What are the study's limitations?

    Summary data; industry trials.

    What does it say about Elawady's specific claim?

    Confirms DKA risk, refutes net harm.

    Do the results apply to Germany and Europe?

    High.

    What can explicitly not be concluded from this study?

    Effects in people following prolonged fasting regimens.

    Scientific details →

  • 816 trials: what each diabetes drug class does and does not do

    Shi Q et al.. BMJ 2023 · PMID 37024129 · DOI 10.1136/bmj-2022-074068
    Meta-analysisindependent cross-checkfull text checked★ key study

    SGLT2 inhibitors and GLP-1 agonists reduce death by about 12%; each class has specific side effects.

    SGLT2i and GLP-1 RA reduce all-cause death (high certainty).

    Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    Compare benefits and harms of all diabetes drug classes.

    How was the study done?

    Network meta-analysis of 816 RCTs with GRADE.

    How many people, animals or samples were studied?

    471,038 patients.

    What was actually found?

    Mortality benefit for SGLT2i and GLP-1 RA; class-specific harms such as DKA and genital infections (SGLT2i), hypoglycaemia (sulfonylureas, insulin), heart failure (TZDs).

    How large was the observed effect?

    Death OR 0.88; DKA OR 2.07; amputation OR 1.27.

    What do the results mean in everyday life?

    No drug is free of side effects; for several classes the benefits clearly outweigh them in people at risk.

    What are the study's limitations?

    Low certainty for older drugs.

    What does it say about Elawady's specific claim?

    Supports 'every class has harms'; refutes 'net harmful'.

    Do the results apply to Germany and Europe?

    High.

    What can explicitly not be concluded from this study?

    Individual treatment choice.

    Scientific details →

  • No sign in trials that SGLT2 drugs damage the brain

    Seminer A et al.. JAMA Neurol 2025 · PMID 40193122 · DOI 10.1001/jamaneurol.2025.0360
    Meta-analysisindependent cross-checkabstract checked

    Dementia OR 1.20 (0.67-2.17) for SGLT2i, not significant; GLP-1 RA OR 0.55.

    No randomised signal of brain harm with SGLT2i (OR 1.20, 0.67-2.17), imprecise.

    Does the study support the specific claim? No · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    Assess dementia risk with cardioprotective diabetes drugs in RCTs.

    How was the study done?

    Meta-analysis of 26 RCTs.

    How many people, animals or samples were studied?

    164,531 participants.

    What was actually found?

    No effect overall; benefit with GLP-1 RAs; SGLT2i neutral but imprecise.

    How large was the observed effect?

    SGLT2i OR 1.20 (0.67-2.17).

    What do the results mean in everyday life?

    Trials do not show brain damage from Forxiga-type drugs.

    What are the study's limitations?

    Dementia rarely measured systematically.

    What does it say about Elawady's specific claim?

    Does not support 'kills the brain'.

    Do the results apply to Germany and Europe?

    High.

    What can explicitly not be concluded from this study?

    A small effect in either direction.

    Scientific details →

  • Most leg amputations in a Swedish region were in people without diabetes

    Johannesson A et al.. Diabetes Care 2009 · PMID 19001192 · DOI 10.2337/dc08-1639
    Cohort studyindependent cross-checkabstract checked

    157 of 290 amputees had no diabetes; risk 8 times higher with diabetes.

    157 of 290 amputees had no diabetes.

    Does the study support the specific claim? No · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    Compare amputation rates with and without diabetes.

    How was the study done?

    10-year regional registry.

    How many people, animals or samples were studied?

    290 amputees.

    What was actually found?

    Amputations occur in people without diabetes too; diabetes raises the rate eightfold.

    How large was the observed effect?

    About 195 vs 23 per 100,000 person-years.

    What do the results mean in everyday life?

    Amputations are caused by blood-vessel disease and diabetes, not only by medicines.

    What are the study's limitations?

    Drug use not studied.

    What does it say about Elawady's specific claim?

    Refutes 'only'.

    Do the results apply to Germany and Europe?

    High.

    What can explicitly not be concluded from this study?

    Effects of individual drugs.

    Scientific details →

  • GLP-1 injections in 60,080 people: fewer deaths, no more pancreas problems

    Sattar N et al.. Lancet Diabetes Endocrinol 2021 · PMID 34425083 · DOI 10.1016/S2213-8587(21)00203-5
    Meta-analysisindependent cross-checkabstract checked★ key study

    Death HR 0.88; MACE HR 0.86; no increase in pancreatic adverse effects.

    All-cause death HR 0.88.

    Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    Pool GLP-1 RA outcome trials.

    How was the study done?

    Meta-analysis of 8 RCTs.

    How many people, animals or samples were studied?

    60,080 patients.

    What was actually found?

    Benefits on heart, kidney and survival; no pancreatic safety signal.

    How large was the observed effect?

    MACE -14%, death -12%.

    What do the results mean in everyday life?

    In large trials these drugs prolonged life and did not cause more pancreatitis.

    What are the study's limitations?

    Exact pancreatitis numbers not in abstract.

    What does it say about Elawady's specific claim?

    Contradicts a clear pancreatitis risk and net harm.

    Do the results apply to Germany and Europe?

    High.

    What can explicitly not be concluded from this study?

    Very rare effects.

    Scientific details →

  • NICE 2026: offer metformin plus an SGLT-2 inhibitor to most adults with type 2 diabetes

    National Institute for Health and Care Excellence (NICE). NICE guideline 2026
    Guideline / position statementindependent cross-checkabstract checked★ key study

    Fewer heart events and heart-failure admissions; DKA and Fournier gangrene 1 per 1,000 or fewer.

    Metformin plus SGLT-2 inhibitor recommended first-line; benefits outweigh risks.

    Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    Recommend first-line diabetes medicines.

    How was the study done?

    Guideline based on meta-analyses.

    How many people, animals or samples were studied?

    Not applicable.

    What was actually found?

    Benefits outweigh risks for most people.

    How large was the observed effect?

    HF hospitalisation 54 vs 26-40 per 1,000 over 3 years.

    What do the results mean in everyday life?

    These medicines are recommended because they prevent heart problems.

    What are the study's limitations?

    UK context.

    What does it say about Elawady's specific claim?

    Contradicts net harm.

    Do the results apply to Germany and Europe?

    High.

    What can explicitly not be concluded from this study?

    Individual choices.

    Scientific details →

Studies with mixed or unclear results (1)

  • Very aggressive blood sugar lowering in high-risk type 2 diabetes

    Action to Control Cardiovascular Risk in Diabetes Study Group; Gerstein HC et al.. N Engl J Med 2008 · PMID 18539917 · DOI 10.1056/NEJMoa0802743
    Randomised controlled trialcited by the Tayebat archivefull text checked★ key study

    Pushing HbA1c below 6% increased deaths by about one-fifth and did not reduce heart attacks or strokes significantly.

    Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim

    Original publication · Scientific details

    Study explained simply
    What did the researchers want to find out?

    Does targeting a normal HbA1c (<6.0%) reduce cardiovascular events in type 2 diabetes with high cardiovascular risk?

    How was the study done?

    Multicentre randomised controlled trial (open-label treatment strategies), mean 3.5 years of intensive therapy

    How many people, animals or samples were studied?

    10,251; Type 2 diabetes, mean age 62.2, median HbA1c 8.1%, established CVD or additional risk factors

    What was actually found?

    More deaths (HR 1.22) and more severe hypoglycaemia with intensive therapy; primary CV outcome not significantly reduced.

    How large was the observed effect?

    HR 1.22 (1.01-1.46) all-cause death; HR 0.90 (0.78-1.04) primary outcome

    What do the results mean in everyday life?

    Very strict sugar targets are not good for everyone, especially older people with heart disease.

    What are the study's limitations?

    Strategy trial: cannot attribute harm to a specific drug; Intensive arm stopped early; High-risk population; not generalisable to early diabetes

    What does it say about Elawady's specific claim?

    Core evidence that near-normal HbA1c targets can harm high-risk type 2 patients (C-INS-04).

    Do the results apply to Germany and Europe?

    Multinational/US/UK/European data; directly transferable to Germany/EU clinical practice.

    What can explicitly not be concluded from this study?

    That insulin specifically caused the deaths, or that lowering high glucose to moderate targets is harmful.

    Scientific details →

Regional context

Germany / EU

European (EASD) and German (DDG) guidance follow the same evidence base as the ADA/EASD consensus: individualised HbA1c targets, insulin as mandatory therapy in type 1 diabetes, and SGLT2 inhibitors/GLP-1 receptor agonists for people with cardiovascular or kidney disease. No country-specific difference changes the assessment.

Egypt

Egypt has one of the highest diabetes prevalences in the region; the same drug classes and insulins are used. Access barriers and cost may make advice to stop medication attractive, which increases the practical risk of this claim. No Egypt-specific evidence changes the assessment.

What applies in my country?

General scientific assessment

False False: dapagliflozin and several other diabetes drugs reduce deaths, heart failure and kidney failure in large trials; there is no evidence that dapagliflozin damages the brain, and amputations also occur in people who never took diabetes drugs.

This statement concerns biological or medical relationships. The scientific assessment above applies regardless of the country; country-specific food data do not change it.

References

  1. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group.. UKPDS Group. Lancet 1998 · PMID 9742977
  2. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes.. Zinman B et al.. N Engl J Med 2015 · PMID 26378978 · DOI 10.1056/NEJMoa1504720
  3. Dapagliflozin in Patients with Chronic Kidney Disease.. Heerspink HJL et al.. N Engl J Med 2020 · PMID 32970396 · DOI 10.1056/NEJMoa2024816
  4. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction.. McMurray JJV et al.. N Engl J Med 2019 · PMID 31535829 · DOI 10.1056/NEJMoa1911303
  5. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy.. Perkovic V et al.. N Engl J Med 2019 · PMID 30990260 · DOI 10.1056/NEJMoa1811744
  6. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes.. Marso SP et al.. N Engl J Med 2016 · PMID 27295427 · DOI 10.1056/NEJMoa1603827
  7. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes.. Marso SP et al.. N Engl J Med 2016 · PMID 27633186 · DOI 10.1056/NEJMoa1607141
  8. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study.. Stratton IM et al.. BMJ 2000 · PMID 10938048 · DOI 10.1136/bmj.321.7258.405
  9. Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).. Davies MJ et al.. Diabetes Care 2022 · PMID 36148880 · DOI 10.2337/dci22-0034
  10. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes.. Neal B et al.. N Engl J Med 2017 · PMID 28605608 · DOI 10.1056/NEJMoa1611925
  11. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes.. Wiviott SD et al.. N Engl J Med 2019 · PMID 30415602 · DOI 10.1056/NEJMoa1812389
  12. Impact of diabetes on the effects of sodium glucose co-transporter-2 inhibitors on kidney outcomes: collaborative meta-analysis of large placebo-controlled trials.. Nuffield Department of Population Health Renal Studies Group; SMART-C Consortium. Lancet 2022 · PMID 36351458 · DOI 10.1016/S0140-6736(22)02074-8
  13. Benefits and harms of drug treatment for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials.. Shi Q et al.. BMJ 2023 · PMID 37024129 · DOI 10.1136/bmj-2022-074068
  14. Cardioprotective Glucose-Lowering Agents and Dementia Risk: A Systematic Review and Meta-Analysis.. Seminer A et al.. JAMA Neurol 2025 · PMID 40193122 · DOI 10.1001/jamaneurol.2025.0360
  15. Incidence of lower-limb amputation in the diabetic and nondiabetic general population: a 10-year population-based cohort study of initial unilateral and contralateral amputations and reamputations.. Johannesson A et al.. Diabetes Care 2009 · PMID 19001192 · DOI 10.2337/dc08-1639
  16. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials.. Sattar N et al.. Lancet Diabetes Endocrinol 2021 · PMID 34425083 · DOI 10.1016/S2213-8587(21)00203-5
  17. Type 2 diabetes in adults: management (NICE guideline NG28), published 2 December 2015, last updated 18 February 2026. National Institute for Health and Care Excellence (NICE). NICE guideline 2026
  18. Effects of intensive glucose lowering in type 2 diabetes.. Action to Control Cardiovascular Risk in Diabetes Study Group; Gerstein HC et al.. N Engl J Med 2008 · PMID 18539917 · DOI 10.1056/NEJMoa0802743

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