Effect of glucose-lowering therapies on heart failure

Area of Science:

• Cardiology
• Endocrinology
• Pharmacology

Background:

• Heart failure is a common complication of diabetes mellitus.
• Effective glucose-lowering therapies are crucial for managing type 2 diabetes patients with heart failure.
• Several glucose-lowering drug classes have varying effects on heart failure outcomes.

Purpose of the Study:

• To review the impact of different glucose-lowering therapies on heart failure outcomes in patients with type 2 diabetes.
• To identify glucose-lowering drugs that improve or worsen heart failure prognosis.
• To determine the optimal glucose-lowering strategy for diabetic patients with or at risk of heart failure.

Main Methods:

• Review of existing clinical trial data and observational studies on glucose-lowering drugs and heart failure.
• Comparative analysis of the effects of metformin, insulin, sulfonylureas, thiazolidinediones, dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor agonists, and SGLT2 inhibitors.
• Evaluation of impact on heart failure hospitalization, cardiovascular death, and overall outcomes.

Main Results:

• Metformin showed modest benefits; insulin's role is unclear.
• Sulfonylureas have controversial effects; thiazolidinediones are contraindicated and can cause heart failure.
• DPP-4 inhibitors may increase heart failure hospitalizations; GLP-1 RAs have varied effects.
• Sodium/glucose cotransporter 2 (SGLT2) inhibitors markedly reduced heart failure hospitalizations and cardiovascular death, particularly empagliflozin.

Conclusions:

• SGLT2 inhibitors demonstrate significant benefits in reducing heart failure hospitalizations and cardiovascular mortality in patients with type 2 diabetes.
• Other glucose-lowering agents have neutral, harmful, or controversial effects on heart failure outcomes.
• SGLT2 inhibitors should be considered the preferred drug class for patients with diabetes and heart failure, or those at high risk.