Key result
SGLT2i and metformin improve outcomes in diabetic HF, while other diabetes drugs prove neutral or detrimental.
This review highlights the bidirectional relationship between heart failure and diabetes, emphasizing that SGLT2 inhibitors and metformin are the only diabetes agents shown to improve outcomes across the heart failure spectrum.
May support SGLT2 inhibitors and metformin preference in heart failure with diabetes; leaves open comparative efficacy of other agents.
People with type 2 diabetes (T2DM) and those with prediabetes have an increased risk of heart failure (HF). Longer duration of T2DM correlates with a greater risk of HF, but HF is also seen in patients with recent-onset diabetes. Insulin resistance is more likely to be present in patients with HF. The risk of HF persists even in the face of standard-of-care preventive treatments for atherosclerotic cardiovascular (CV) disease. HF is commonly the presenting symptom of CV disease in people with diabetes and is the most expensive complication of diabetes because of the high cost of hospitalizations. Recently hospitalization for HF has been included in CV outcome trials (CVOTs), including for medications that are used to treat T2DM, which has led to new therapies for all HF patients. In addition, these CVOTs have shown that many drugs used in the therapy of diabetes are either neutral or detrimental in the HF patient and should be used with caution in patients with existing HF or those at high risk of HF. Most recently, sodium-glucose cotransporter-2 receptor blockers have shown efficacy in both HF with reduced ejection fraction (EF) and HF with preserved EF. The only other oral or injectable diabetes agent shown to improve outcomes in both is metformin.
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Jerkins et al. (2023) conducted a review in Heart failure and type 2 diabetes.
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