Diabetocardiology: a new subspecialty?
Key result
SGLT2 inhibitors provide substantial benefits in patients with heart failure across the entire spectrum of ejection fraction, regardless of type 2 diabetes status.
Key Points
- To review the clinical evolution and therapeutic expansion of SGLT2 inhibitors from glycemic control agents to cornerstone therapies in heart failure and chronic kidney disease.
- Synthesized mechanistic and clinical evidence on sodium-glucose cotransporter-2 inhibitors (gliflozins) originally indicated for type 2 diabetes.
- Evaluated outcomes across diverse patient subsets, including those with heart failure across all ejection fraction ranges and chronic kidney disease.
- SGLT2 inhibitors induce glucosuria by inhibiting glucose reabsorption in the renal proximal tubule, lowering circulating glucose in type 2 diabetes.
- Gliflozins confer substantial heart failure benefits of equal magnitude in patients with and without type 2 diabetes, spanning the entire spectrum of ejection fraction.
- Therapy consistently slows the progression of chronic kidney disease, including diabetic kidney disease.
Structured PICO
P
Population
Patients with heart failure (across the entire spectrum of ejection fraction) and/or chronic kidney disease, with or without type 2 diabetes
I
Intervention
Sodium glucose cotransport inhibitors (SGLT2i) / gliflozins
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“We are in the midst of two pandemics: heart failure and type 2 diabetes. As cardiologists, we have to learn how to deal with this.”
“This was totally unexpected. I remember when this paper was published, a lot of people just shook their heads and said, 'We can't quite believe it.' We're trying to find out if it's dangerous for the heart, and here we see a reduction for heart failure hospitalization, a reduction for cardiovascular deaths. This has to be repeated. Who knows if this is right or if it's just the play of chance.”
MKMikhail KosiborodDirector of cardiometabolic research, Saint Luke's Mid America Heart Institute
“The main driving factor behind this meeting was a realization that the intersection of diabetes and CVD is becoming its own field. It transcends the traditional specialty boundaries. It's rapidly growing and expanding.”
Implication
SGLT2 inhibitors represent a paradigm shift in the management of heart failure and chronic kidney disease, extending their utility beyond diabetes.
Abstract
Early in this century, amid a marked global increase in the prevalence of type 2 diabetes (T2D), a new class of anti-diabetic drugs—the sodium glucose cotransport inhibitors (SGLT2i), often referred to as the gliflozins, was developed. By blocking the reabsorption of glucose in the proximal renal tubule, they cause glucosuria. The resulting reduction in the circulating glucose led to their approval for the treatment of T2D. A serendipitous finding was that gliflozins are also beneficial in patients with heart failure (HF). What came as a surprise to many, including this author, was that this benefit was substantial, was equal in magnitude in patients with and without T2D, and was observed in HF patients across the entire spectrum of ejection fraction. These observations led to a paradigm shift in the management of HF. Furthermore, the gliflozins also slow the progression of chronic kidney disease (CKD), including diabetic kidney disease (DKD).1
Discussion
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Cite This Study
Eugene Braunwald (2023) conducted an editorial in Type 2 diabetes, heart failure, chronic kidney disease. SGLT2 inhibitors was evaluated. SGLT2 inhibitors provide substantial benefits in patients with heart failure across the entire spectrum of ejection fraction, regardless of type 2 diabetes status.