SGLT2 Inhibitors Lower T2D Risk in People With Heart Failure

TOPLINE:
Treatment with sodium-glucose cotransporter 2 inhibitors (SGLT2i) was associated with a reduced incidence of type 2 diabetes (T2D), all-cause mortality, and heart failure (HF)-related adverse outcomes.
METHODOLOGY:
A retrospective cohort analysis of TriNetX patients with HF, without baseline diabetes, prescribed either angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARBs), with or without SGLT2i.
After propensity score matching, there were 39,168 patients each in ACEi/ARB + SGLT2i and ACEI/ARB alone groups.
TAKEAWAY:
The incidence of T2D was reduced with SGLT2i (hazard ratio, 0.58; 95% CI, 0.50-0.67) compared with ACEi/ARBs alone.
Also lower in the SGLT2i than in ACEi/ARB alone groups were all-cause mortality (0.56; 0.54-0.59), acute pulmonary oedema (0.75; 0.65-0.87), and hospitalisation (0.71; 0.69-0.73).
In subgroup analyses, patients with prediabetes who were prescribed SGLT2i + ACEi/ARB had a reduced incidence of T2D (0.60; 0.43-0.84) vs ACEi/ARBs alone, and also lower all-cause mortality (0.55; 0.46-0.65), and hospitalisation (0.77; 0.71-0.85), but not pulmonary oedema (1.26; 0.83-1.91).
The reduction in T2D risk was greater with dapagliflozin (0.46; 0.36-0.58) than with empagliflozin (0.66; 0.55-0.80).
IN PRACTICE:
“The T2D preventative effects of SGLT2i should be assessed in broader clinical populations to examine the impact on long-term clinical outcomes. Further exploration into the physiological processes underpinning T2D prevention and a health economic evaluation of such an intervention are merited,” the authors wrote.
SOURCE:
The study was conducted Alex E. Henney, MBChB, of Liverpool University Hospitals NHS Foundation Trust, Liverpool UK, and colleagues and it was published online August 7, 2024, in Diabetes, Obesity and Metabolism.
LIMITATIONS:
Real-world data, not randomised or controlled. Potential for missing data from electronic health records. A higher proportion of patients in the ACEi/ARB + SGLT2i arm were also prescribed diuretics for relief of congestive symptoms, thereby affecting exercise capacity and insulin resistance. Potential unknown confounders. Could not determine if patients were prescribed/treated with other glucose-lowering medications during the follow-up period, or changed agents within the SGLT2i drug class.
DISCLOSURES:
Alex E. Henney has no disclosures, but another author receives a fellowship from the Novo Nordisk UK research foundation and JDRF. Another author has received investigator-initiated grants from Astra Zeneca and Novo Nordisk, support for education from Perspectum with financial remuneration from pharmaceutical company consultation made to the University of Liverpool. A third author has received honoraria from Procter & Gamble, Viatris, Grunenthal, and Sanofi for educational meetings and funding for attendance to an educational meeting from Diiachi Sankyo, and investigator-led funding by Procter & Gamble.
 
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