Abstract 12642: Heart Failure Prognosis in Diabetic Patients on SGLT2 (Sodium-Glucose Cotransporter-2) Inhibitors: A Systematic Review and Meta-Analysis

Abstract

Introduction: Cardiovascular disease complications predominantly increase the incidence of mortality and hospitalizations in the setting of type-2 diabetes. This systematic review and meta-analysis aimed to evaluate the therapeutic impact of SGLT-2 (sodium-glucose cotransporter-2) inhibitors on heart failure prognosis in patients with type-2 diabetes. Methods: We systematically explored PubMed/Medline, JSTOR, Google Scholar, and Cochrane Library for relevant randomized controlled trials published between January 2015 and April 2020, evaluating the effect of SGLT-2 inhibitors on cardiovascular outcomes. The main outcomes included (1) overall MACEs (MI, stroke, cardiovascular death), (2) overall CV death, (3) overall hospitalization for heart failure, (4) overall kidney outcomes (worsening kidney disease, need for dialysis or transplant, and death due to kidney disease), (5) adverse outcomes (each of genital infections, hypoglycemia, and amputation risk). Results: We extracted nine studies that included a total of 1,33,276 adult patients with type-2 diabetes and a predisposition for heart failure complications. Compared to placebo, patients receiving SGLT2 inhibitors had a lower incidence of MACE (OR: 0.80 [95% CI 0.71, 0.90]), cardiovascular deaths (OR: 0.85 [95% CI 0.77, 0.94]), worsening kidney disease, need for dialysis/transplant, death due to kidney disease (OR 0.65 [95% CI 0.48, 0.87]), and all-cause mortality (OR: 0.86 [95% CI 0.80, 0.94] p=0.0007). The patients on SGLT2 inhibitors did not experience a reportable reduction in genital infections, hypoglycemia, and amputation risk compared to placebo. The moderate heterogeneity of most studies was determined by their (31%-80%) I-square values. Conclusions and Relevance: This meta-analysis revealed moderately heterogeneous but statistically significant outcomes confirmed the role of SGLT-2 inhibitors in reducing the incidence of worsening kidney disease, all-cause mortality, overall kidney outcomes, hospitalization for heart failure, cardiovascular deaths, and overall MACEs in the setting of diabetes mellitus.