Abstract
The incidence of both diabetes mellitus type 2 and heart failure is rapidly growing, and the diseases often coexist. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are a new antidiabetic drug class that mediates epithelial glucose transport at the renal proximal tubules, inhibiting glucose absorption—resulting in glycosuria—and therefore improving glycemic control. Recent trials have proven that SGLT2i also improve cardiovascular and renal outcomes, including reduced cardiovascular mortality and fewer hospitalizations for heart failure. Reduced preload and afterload, improved vascular function, and changes in tissue sodium and calcium handling may also play a role. The expected paradigm shift in treatment strategies was reflected in the most recent 2021 guidelines published by the European Society of Cardiology, recommending dapagliflozin and empagliflozin as first-line treatment for heart failure patients with reduced ejection fraction. Moreover, the recent results of the EMPEROR-Preserved trial regarding empagliflozin give us hope that there is finally an effective treatment for patients with heart failure with preserved ejection fraction. This review aims to assess the efficacy and safety of these new anti-glycemic oral agents in the management of diabetic and heart failure patients.
Highlights
Diabetes mellitus type 2 (T2DM) is a rapidly growing metabolic disorder affecting over 400 million people worldwide [1]
Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are effective antidiabetic therapies in T2DM patients that are associated with better glycemic control and reductions in body mass and blood pressure
McGuire et al performed a meta-analysis of six trials (EMPA-REG OUTCOME, CANVAS and CANVAS-R, DECLARETIMI 58, CREDENCE, and VERTIS CV on ERTU) [85], including a total of 46,969 unique T2DM patients; 66.2% had atherosclerotic cardiovascular disease (ACVD)
Summary
Diabetes mellitus type 2 (T2DM) is a rapidly growing metabolic disorder affecting over 400 million people worldwide [1]. The Canagliflozin Cardiovascular Assessment Study (CANVAS) demonstrated the potential of CANA to reduce the risk of CV complications in T2DM patients, including non-fatal stroke, non-fatal MI, and HF management, further highlighting the cardioprotective qualities of SGLT2i and their role in T2DM treatment, in conjunction with first-line treatment with MET [11]. The FDA refused to approve its use in combination with insulin for diabetes mellitus type 1 (T1DM), and phase III trials on SOTA in patients with T2DM and HF were regrettably and untimely terminated due to financial reasons and the COVID-19 pandemic. CANA, DAPA, EMPA, ERTU, and SOTA are recommended in T2DM patients at risk of CV events in order to reduce hospitalizations due to HF, major CV events, endstage renal disease (ESRD), as well as CV death ( class I) [6]. This review aims to assess the efficacy and safety of these new anti-glycemic oral agents in the management of diabetic and HF patients
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