SGLT2 inhibitors, or drugs used to treat type 2 diabetes, significantly reduce hospitalizations and mortality for diabetic patients with heart failure (HF).
Published in Circulation, the findings support a decade of research on SGLT2 inhibitors, including the 2015 EMPA-REG OUTCOME trial, led by endocrinologist Silvio Inzucchi, MD.
Individuals with type 2 diabetes are more likely to develop heart failure, a life-threatening condition in which the heart is unable to pump blood effectively. Prior treatments for patients with type 2 diabetes showed no benefit for heart failure, some even showing harm. This new class of drugs reduces blood sugar by allowing the body to excrete excess glucose in the urine.
“Numerous trials including DAPA-HF and now EMPEROR-Reduced, support the clinical benefit of SGLT2 inhibition in patients with chronic heart failure. These studies can advance our knowledge and improve communication about the use of these drugs,” said Jeffrey Testani, MD, senior author of the study.
In the EMPA trial, the authors aimed to better understand the renal and diuretic actions of the SGLT2 inhibitors. Twenty patients with type 2 diabetes and heart failure were randomized to receive once-daily doses of either the glucose-lowering drug empagliflozin (10 mg doses), or a placebo for 14 days, followed by crossover to the alternate therapy.
Numerous trials including DAPA-HF and now EMPEROR-Reduced, support the clinical benefit of SGLT2 inhibition in patients with chronic heart failure.
Jeffrey Testani, MD
At the end of the trial period, the investigators found that patients treated with the drug experienced substantially better response to loop diuretics and reductions in plasma and blood volume, compared to those on placebo. A growing body of evidence shows that controlling blood volume has a significant clinical impact and provides an accurate means to measure blood composition.
Given that fluid overload is one of the most common causes of symptoms and hospitalization in HF, these observations help to explain the dramatic reduction in heart failure hospitalization seen with SBLT2 inhibitors.
The study was presented Nov. 16, 2019 at the American Heart Association Scientific Sessions in Philadelphia, Pa.