The present review thoroughly evaluates the long-term safety, efficacy and cardiovascular outcomes of glucagon-like peptide-1 receptor agonists in the management of type 2 diabetes mellitus. The study was performed in major biomedical databases including PubMed, Embase and the Cochrane Library. The search strategy combined keywords terms related to GLP-1 receptor agonists, type 2 diabetes, safety, efficacy, cardiovascular outcomes and clinical trials. A comprehensive review of clinical trials, meta-analyses and safety reports demonstrates that GLP-1 receptor agonists (RAs) produce significant reductions in glycated hemoglobin (HbA1c) levels, ranging from 0.8% to 1.5%, along with substantial weight loss of 2–6 kg. In addition to controlling blood sugar, research shows that GLP-1 RAs can protect the kidneys and improve heart health. Also, it consistently lower major adverse cardiovascular events and cause mortality in high-risk patients. However, combination regimens incorporating insulin, sulfonylureas or SGLT2 inhibitors significantly improve glycemic control and weight outcomes without a notable rise in adverse events. Even though cardiovascular outcome trials are different from each other, the overall evidence supports the use of GLP-1 RAs as a key part of modern T2DM treatment. Subsequent investigations to emphasize long-term renal safety, biomarker driven individualized therapy and the preparation of novel formulations stratagies to enhance clinical outcomes and recommended customized patient care.