Across 34 studies and 15,656 adults with type 2 diabetes, patients consistently ranked glycaemic efficacy, cardiovascular risk reduction and simple administration as their top priorities when weighing GLP-1 receptor agonists, SGLT-2 inhibitors, tirzepatide and finerenone. Oral once-daily pills and once-weekly injectables with easy devices were favoured. Weight loss mattered but ranked below glucose and heart benefits. Both drug classes were preferred over DPP-4 inhibitors, thiazolidinediones and insulin, with no clear winner between SGLT-2i and GLP-1 RA. Evidence certainty was low or very low, and no finerenone studies existed.
The finding runs against the public narrative that weight loss drives demand for these drugs. Among people already living with type 2 diabetes, hard outcomes and convenience come first, which fits what trials show: SGLT-2 inhibitors and GLP-1 agonists reduce cardiovascular events and kidney decline beyond glucose lowering. The practical message for adults is to ask which outcome matters most to you, whether heart protection, kidney protection, A1c, weight or injection burden, and to use that in a shared decision with your clinician. Limitations are substantial. Most included studies were small, heterogeneous survey or discrete-choice designs, and the single tirzepatide-versus-semaglutide preference rests on one study. The absence of finerenone data is a real gap, given its kidney and heart indications. The review is confirmatory rather than paradigm-shifting, but it usefully highlights that preference evidence trails far behind the efficacy evidence for newer agents.