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Conclusions Using GLP-1RAs versus insulin for type 2 diabetes patients requiring intensified injection therapy in clinical practice is cost-effective.

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The evidence, SELECT, n=17,604 First MACE: HR 0.80, 95% CI 0.72 to 0.90 Non-fatal MI: HR 0.72, 95% CI 0.61 to 0.85 Coronary revascularisation: HR 0.77, 95% CI 0.68 to 0.87 All-cause : HR 0.81, 95% CI 0.71 to 0.93 (Lincoff et al, NEJM 2023) Benefit appeared early, before substantial weight loss, supporting a mechanism partly independent of weight reduction