The Evolution of Sodium-Glucose Co-Transporter-2 Inhibitors in Heart Failure

Sodium-glucose co-transporter-2 (SGLT2) inhibitors have evolved over the years, based on data from several randomized, double-blinded, placebo-controlled clinical trials. Formerly used primarily for blood sugar control in patients with diabetes, they are now used to decrease the risk of hospitalization for heart failure (HF), or of death from cardiovascular (CV) causes, in patients with heart failure with reduced ejection fraction (HFrEF). They have also been shown to slow the progression of renal disease and prevent death related to renal causes in patients with chronic kidney disease (CKD). They are currently being studied to decrease the risk of HF hospitalization in patients with preserved ejection fraction subtype and have shown positive results. The transition of SGLT2 from a medication used in diabetes to an established HF medication was a result of the hypothesis generated from the analysis of earlier trials in diabetic patients and further testing of this hypothesis in an HF population. By way of this review, we aim to highlight the rationale for the paradigm shift of SGLT2 inhibitors from their use in diabetic patients to their use in all patients with HF, regardless of the presence of diabetes. To support our recommendation, we'll present detailed results of several major clinical trials and a meta-analysis study that led to this discovery, along with clinical indication for the same.