The management of patients with type 2 diabetes (T2D) and heart failure (HF) is challenging, and the optimal care for these patients is not very well defined. The coexistence of these two conditions increases morbidity and mortality. Patients with HF and T2D are at an increased risk for cardiovascular-related mortality and have higher rates of HF hospitalizations. Almost a quarter of all HF patients are readmitted to the hospital within 30 days of discharge; nearly half are hospitalized 4 or more times, and these patients often have cardiometabolic comorbidities—furthering the risks of hospitalization and readmission. Glycemic control in patients with T2D and HF can be complex for clinicians, for example, thiazolidinediones are known to increase HF risk. However, recent studies have suggested that newer antihyperglycemic medications, particularly SGLT-2 inhibitors, can improve HF risk and reduce hospitalizations for HF in T2D.
Data from the cardiovascular outcome trials (CVOTs) of antidiabetic drugs have not only revealed exciting information about cardiovascular and renal benefits of the newer drugs, but also about HF risk in T2D. A recent meta-analysis of nine CVOTs that included 87,162 subjects showed that SGLT-2 inhibitors are associated with a decreased risk of HF hospitalizations compared with placebo. In addition, GLP-1 agonists and DPP-4 inhibitors were not associated with a significant risk reduction in HF hospitalization rates. In a class ranking, the authors reported that with 99.6% probability, SGLT-2 inhibitors are the most effective drugs to reduce the risk of HF hospitalizations in patients with T2D, followed by GLP-1 agonist and DPP-4 inhibitors. The meta-analysis included SGLT-2 inhibitors empagliflozin and canagliflozin, GLP-1 agonists lixisenatide, liraglutide, semaglutide, and once-weekly exenatide, and DPP-4 inhibitors alogliptin, saxagliptin, and sitagliptin.