How beneficial is sodium-glucose co-transporter 2 inhibitor treatment for patients with type 2 diabetes mellitus and heart failure?

This study reviewed the long-term use of sodium-glucose co-transporter 2 inhibitors (SGLT-2i) on the risk of mortality and hospitalization for heart failure (HHF) in patients with type 2 diabetes (T2D) and heart failure (HF). The authors concluded that long-term use of SGLT-2 inhibitors can help to reduce mortality risk and HHF in these patients.

T2D predisposes patients to a higher risk of premature mortality and heart failure (HF; the inability of heart muscles to effectively pump blood around the body). Although T2D poses a risk factor for HF, HF is also a risk factor for T2D. However, T2D and HF are separately managed with different treatment strategies.

SGLT-2i are oral glucose-lowering drugs that reduce blood glucose levels by increasing the amount of glucose that is passed in the urine. Some evidence suggests that SGLT-2i such as empagliflozin (Jardiance) and canagliflozin (Invokana) may be useful in treating HF in the long term. Other short-term studies reported different effects on HF. There is a need to summarize the effect of long-term use of SGLT-2is on mortality and HHF in patients with T2D to identify which patients would best benefit from treatments.

This review analyzed 5 studies that included patients with T2D and HF on long-term treatment with SGLT-2i. The CANVAS study compared canagliflozin to placebo. The DAPA-HF and DECLARE-TIMI 58 studies compared dapagliflozin (Farxiga) to placebo. The EMPEROR-Reduced study compared empagliflozin to placebo. The SOLOIST-WHF study compared sotagliflozin (Zynquista) to placebo. Cardiovascular (CV) death or HHF, CV death only, HHF only, and all-cause mortality were evaluated.

A 31% risk reduction in the occurrence of CV death or HHF was observed with SGLT-2i compared to placebo. A 20% risk reduction in CV death occurred with SGLT-2i compared to placebo. A 33% risk reduction in HHF was observed with SGLT-2i compared to placebo. A 26% risk reduction occurred in all-cause mortality with SGLT-2i compared to placebo.

These benefits were seen mostly in patients with both T2D and HF and less in those with T2D or HF alone.

The study showed that patients with both T2D and HF benefit from SGLT-2i treatment in terms of CV mortality and HHF.

This review included some studies that used varied dosing schedules and patients with a history of HF. This has the potential to introduce bias. Some participants also had more than one other medical condition and used background medications.