Key result
In a cross-sectional analysis of 571 heart failure patients with type 2 diabetes, SGLT2-inhibitor use was only 1%, despite 32% of patients meeting eligibility criteria for their use.
Why the study?
The choice of glucose-lowering agents in heart failure can strongly influence HF-related adverse events, but little data exist regarding their selection in patients with both HF and type 2 diabetes.
Cross-Sectional (n=571)
No
Despite potential eligibility, SGLT2 inhibitors remain underused in contemporary heart failure patients with type 2 diabetes.
SGLT2 inhibitors remain underused despite eligibility in HF with T2D; leaves open implementation barriers and need for prospective studies.
Background: The choice of glucose lowering agent in heart failure (HF)-patients can have a strong effect on HF-related adverse events, with some classes increasing and other classes reducing the risk. Little data is available about the choice of glucose lowering agents in HF-patients with type-2-diabetes.Methods: We performed a cross-sectional single centre point analysis of all patients with both a diagnoses of HF and type-2-diabetes followed in a tertiary HF-clinic. Medical records were used to determine the choice of current glucose lowering agent. Data at the time of cross-sectional analysis was used to determine potential eligibility to a sodium-glucose-linked-transporter-2-inhibitor (SGLT2-inhibitor) based on the enrolment criteria of the EMPAREG-OUTCOME-trial.Results: A total of 571 HF-patients with diabetes were assessed on June the first 2017. The majority of patients were either managed with one or two glucose lowering agents (43% respectively 34%), with metformin (N = 391;61%), Insulin (N = 278;49%) and sulfonylurea (N = 259;45%) being the most frequently employed treatments. SGLT2-inhibitor use was low (N = 7;1%). According to trial criteria 184 patients (32%) qualified for an SGLT2-inhibitor. With main reasons for ineligibility being a HbA1C < 7% (N = 324) or a glomerular-filtration-rate <30 ml/min (N = 154; of whom 101 patients overlapped with HbA1C < 7%). However 54% of patients with a HbA1C < 7% were treated with ≥2 glucose lowering agents from a class other than SGLT-2-inhibiton.Conclusion: Despite potential eligibility, SGLT2-inhibition remains an underused glucose lowering agent in this contemporary HF-population. Additional research is necessary on optimising its implementation in clinical practice, which might include switching glucose lowering therapies in patients at HbA1C-target.
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Martens et al. (2019) conducted a cross-sectional in Heart failure and type 2 diabetes (n=571). Glucose lowering agents (including SGLT2-inhibitors) was evaluated on Current glucose lowering agent use and potential eligibility for SGLT2-inhibitors. In a cross-sectional analysis of 571 heart failure patients with type 2 diabetes, SGLT2-inhibitor use was only 1%, despite 32% of patients meeting eligibility criteria for their use.
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