Glucose-lowering drugs have varying effects on heart failure in type 2 diabetes, with SGLT2 inhibitors and metformin showing positive effects, while others have neutral or negative effects.
This review highlights the differential effects of glucose-lowering medications on heart failure outcomes in patients with type 2 diabetes, emphasizing the positive effects of SGLT2 inhibitors and metformin.
In people with type 2 diabetes the frequency of heart failure (HF) is increased and mortality from HF is higher than with non-diabetic HF. The increased frequency of HF is attributable to the cardiotoxic tetrad of ischaemic heart disease, left ventricular hypertrophy, diabetic cardiomyopathy and an extracellular volume expansion resistant to atrial natriuretic peptides. Activation of the renin-angiotensin-aldosterone system and sympathetic nervous systems results in cardiac remodelling, which worsens cardiac function. Reversal of remodelling can be achieved, and cardiac function improved in people with HF with reduced ejection fraction (HFrEF) by treatment with angiotensin-converting enzyme inhibitors and β-blockers. However, with HF with preserved ejection fraction (HFpEF), only therapy for the underlying risk factors helps. Blockers of mineralocorticoid receptors may be beneficial in both HFrEF and HFpEF. Glucose-lowering drugs can have a negative effect (insulin, sulphonylureas, dipeptidyl peptidase-4 inhibitors and thiazolidinediones), a neutral effect (α-glucosidase inhibitors and glucagon-like peptide-1 receptor agonists) or a positive effect (sodium-glucose co-transporter-2 inhibitors and metformin).
Bell et al. (Tue,) conducted a review in Type 2 diabetes and heart failure. Glucose-lowering medications was evaluated. Glucose-lowering drugs have varying effects on heart failure in type 2 diabetes, with SGLT2 inhibitors and metformin showing positive effects, while others have neutral or negative effects.