Key result
SGLT2 inhibitors are preferred for T2D with HF while pioglitazone and saxagliptin must be avoided.
Why the study?
The coexistence of T2DM and HF markedly increases morbidity and mortality, making early diagnosis, prevention, and adequate treatment of major importance.
Does the choice of antidiabetic drug affect heart failure incidence, hospitalization, and outcomes in patients with type 2 diabetes mellitus and heart failure?
Does the choice of antidiabetic drug affect heart failure incidence, hospitalization, and outcomes in patients with type 2 diabetes mellitus and heart failure?
SGLT2 inhibitors are the preferred glucose-lowering agents for patients with concurrent type 2 diabetes and heart failure, while pioglitazone and saxagliptin should be avoided.
May support SGLT2i preference while avoiding pioglitazone and saxagliptin in T2DM-HF; leaves open need for confirmatory RCTs.
INTRODUCTION: There is a bi-directional link between type 2 diabetes mellitus (T2DM) and heart failure (HF) and their co-existence markedly increases an individual's morbidity and mortality. Therefore, it is of major importance to diagnose early (and, even better, prevent) HF in T2DM patients, as well as adequately treat T2DM patients with HF. AREAS COVERED: The present narrative review discusses the effects of different antidiabetic drugs [metformin, pioglitazone, sulphonylureas (SUs), dipeptidyl peptidase 4 inhibitors (DPP4i), glucagon-like peptide-1 receptor agonists (GLP-1 RAs), sodium-glucose cotransporter 2 inhibitors (SGLT2i) and insulin] on HF incidence, hospitalization and outcomes. Current guidelines of diabetes and cardiology societies on this issue are also commented on. EXPERT OPINION: Metformin (+lifestyle interventions) is the first-line treatment for all T2DM patients and SGLT2i are the preferred drugs (class I, level of evidence A) in patients with T2DM and HF. Pioglitazone is contraindicated in HF, whereas SUs, DPP4i, GLP-1 RAs and insulin are considered as neutral. However, SUs may cause hypoglycemia and weight gain, saxagliptin (a DPP4i) must be avoided in this setting and GLP-1 RAs seem not to affect HF risk. There is an urgent need of increasing guidelines implementation regarding SGLT2i use in clinical practice, to sufficiently tackle the HF burden in T2DM.
No takes yet. Share an insight, caveat, or question.
Katsiki et al. (2022) conducted a review in Type 2 diabetes mellitus and heart failure. Antidiabetic drugs (metformin, SGLT2i, pioglitazone, SUs, DPP4i, GLP-1 RAs, insulin) was evaluated. SGLT2 inhibitors are the preferred drugs for patients with type 2 diabetes and heart failure, whereas pioglitazone is contraindicated and saxagliptin must be avoided.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: