Key result
SGLT-2 inhibitors lower E/e' ratio by ~1.5 versus DPP-4 inhibitors in AF and diabetes.
Why the study?
The efficacy of SGLT-2 inhibitors on diastolic cardiac function in patients with AF and diabetes mellitus has not been well evaluated.
Does SGLT-2 inhibitor therapy improve diastolic function compared to DPP-4 inhibitor therapy in patients with atrial fibrillation and diabetes mellitus?
RCT (n=121)
Open-label, adjudicator-masked
1:1 ratio, block size of 4, stratified by study site
Yes
Does SGLT-2 inhibitor therapy improve diastolic function compared to DPP-4 inhibitor therapy in patients with atrial fibrillation and diabetes mellitus?
In patients with atrial fibrillation and diabetes, SGLT-2 inhibitors significantly improved echocardiographic parameters of diastolic function (E/e' ratio) compared to DPP-4 inhibitors, particularly in those with elevated baseline left atrial pressure.
SGLT-2i may improve diastolic parameters over DPP-4i in AF with DM; leaves open clinical outcome benefits.
The efficacy of sodium–glucose cotransporter-2 inhibitors (SGLT-2i) on diastolic cardiac function in patients with atrial fibrillation (AF) and diabetes mellitus (DM) has not been well evaluated. This open-label multicenter randomized trial evaluated whether SGLT-2i therapy is more effective than dipeptidyl peptidase-4 inhibitors (DPP-4i) in improving diastolic function in patients with AF and DM. The primary outcome was the change in E/e′ from baseline to 10-month follow-up echocardiography. A total of 121 patients from two centers in South Korea were enrolled (mean age 67.7 years; 32.2% women; mean hemoglobin A1c level 7.5%). Sixty-one patients were assigned to the SGLT-2i group and 60 to the DPP-4i group, with all participants adhering to their assigned medications. At the 10-month follow-up, the reduction in E/e′ was significantly greater in the SGLT-2i group than in the DPP-4i group (between-group difference − 1.52; 95% CI, -2.75 to -0.29; P = 0.017). This beneficial effect of SGLT-2i was prominent in patients with baseline E/e’ >14. No deaths or major cardio-cerebrovascular events occurred during the study period. The incidence of adverse events did not differ significantly between the groups. In conclusion, treatment with SGLT-2i significantly improved echocardiographic parameters of diastolic function compared with DPP-4i in patients with AF and DM.
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Cho et al. (2026) conducted an RCT in Atrial fibrillation and Type 2 Diabetes Mellitus (n=121). SGLT-2 inhibitors vs. DPP-4 inhibitors was evaluated on Change in E/e′ ratio from baseline to 10-month follow-up (MD -1.52, 95% CI -2.75 to -0.29, p=0.017). SGLT-2 inhibitors significantly reduced the E/e' ratio by a mean difference of -1.52 compared with DPP-4 inhibitors in patients with atrial fibrillation and diabetes mellitus.
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