EFFICACY OF SGLT2I IN ACUTE DECOMPENSATED HEART FAILURE WITH TYPE 2 DIABETES MELLITUS

Abstract

Objective: We hypothesized that Sodium Glucose cotransporter 2 inhibitors (SGLT2i) exerts positive effects in patients admitted with ADHF and type 2 diabetes mellitus (T2DM). Design and method: Prospective case control study with 1-month follow up. All the patients who admitted to Cardiology center, Hue Central Hospital between 01/12/2020 and 01/06/2021. Inclusion criteria: Adults diagnosed with T2DM with hypervolemic ADHF reduce LVEF and planned treatment with IV loop diuretic therapy. Exclusion criterias: fasting blood glucose (FBG) < 4.4 mmol/L, Systolic blood pressure < 90mmHg, requires inotrope therapy, eGFR < 30 ml/min/1.73m2, severe anemia, breastfeeding or pregnant, severe AS or MS without repair, severe hepatic impairment, acute coronary syndrome or history of coronary artery stenting. The study primary end-point: Length of hospitalization, in-hospital death, death within 30 days after discharge and re-hospitalized within 30 days. The study safety end-point: Urinary tract infection, worsening renal function, ketonacidosis or hypovolemic shock. Results: The proportion of in-hospital mortality, 30-days mortality and the length of hospitalization by day tended to be higher in the group of patients not using SGLT2i but not significant. The proportion of re-hospitalized for 30 days was higher in group not using SGLT2i (p = 0.014). The patient group of non-SGLT2i using re-hospitalized sooner than the patient using SGLT2i (p = 0.029). The eGFR of the patient use the SGLT2i show significantly improvement after 30 days (p = 0.024) but in day 4, it’s shown no improvement. In patient who don’t use the agent, the eGFR get worst in day 4 with p = 0.01 then it improve in day 30 but not significant. The group of using SGLT2i seems much more effective in reduce NT-proBNP and FBG (p values: NT-proBNP:0.026 to 0.044; FBG: 0.021 to 0.038, respectively). Complications that should be considered in patients using SGLT2i were UTIs and discontinuation of treatment due to feeling lose weight too fast. Conclusions: The using of SGLT2i reduce the numbers of re-hospitalization in first 30-day after discharged, prolong the duration between re-hospitalization period and only the patient groups using SGLT2i could improve the eGFR after 30-days with no significant adverse effects.