GLP-1 receptor agonists and microvascular complications in type 2 diabetes mellitus: an integrative literature review

Type 2 diabetes mellitus (T2DM) is a major global public health challenge and is strongly associated with cardiovascular and microvascular complications, particularly diabetic kidney disease (DKD), a leading cause of morbidity, mortality, and progression to renal replacement therapy. Current evidence indicates that strategies focused solely on glycemic control are insufficient to effectively reduce cardiorenal risk. In this context, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as an important therapeutic class, providing metabolic and cardiorenal benefits beyond glucose lowering. This integrative review aimed to critically evaluate the effects of GLP-1 RAs on the prevention and progression of microvascular complications in patients with T2DM, with a particular focus on diabetic nephropathy. Sixteen studies published between 2017 and 2025 were analyzed. The findings indicate that GLP-1 RAs reduce albuminuria, modulate inflammatory and oxidative pathways, and confer consistent cardiovascular protection, although their ability to preserve estimated glomerular filtration rate appears inferior to that of sodium–glucose cotransporter 2 inhibitors (SGLT2i). Notably, GLP-1 RA therapy was associated with a reduction in severe ophthalmologic complications and lower risk of vision-threatening outcomes. Overall, the evidence suggests that GLP-1 RAs play a significant role in early stages of diabetic microangiopathy and that their use as part of a multimodal cardiorenal strategy may enhance clinical outcomes and slow disease progression.