Sodium Glucose Cotransporter 2 Inhibitors and Heart Failure

Sodium Glucose cotransporter 2 (SGLT2) inhibitors are a new class of drugs that are currently used for the treatment of patients with type 2 diabetes mellitus as well as for patients with heart failure and they have been shown to reduce the risk of developing worsening heart failure.

Recent studies have also shown these drugs can decrease the risk of cardiac death and serious events and are safe for patients who currently suffer from heart failure even if they do not have diabetes.

What they do: In patients with diabetes mellitus SGLT2 inhibitors block the reabsorption of the blood sugar glucose in the kidney, leading to the loss of glucose and mildly increasing urination. As a result, SGLT2 inhibitors lower blood glucose levels, and patients generally lose some weight (2-4 kg), while blood pressure might be lowered to a mild degree.

In patients with heart failure, the effects of SGLT2 inhibitors within the body are complex and include an improvement of cardiac and muscular metabolism, an improvement of kidney function as well as the benefits of the mild diuretic effect, all which can reduce the symptoms of congestion in heart failure.

What are the expected benefits? In patients with heart failure, SGLT2 inhibitors have been shown to reduce heart failure-related hospitalizations, prolong life, prevent kidney problems, and improve exercise tolerance and quality of life. SGLT2 inhibitors reduce blood glucose in patients with diabetes mellitus but not in patients without type 2 diabetes mellitus.

Side effects: SGLT2 inhibitors are generally well tolerated in patients with heart failure and have the same occurrence of side effects as placebo. In patients with type 2 diabetes mellitus the most frequent side effects are fungus infections of the urogenital tract and organs, mostly requiring topical (cream) treatment for several days. More rare side-effects include dizziness if the blood pressure drops, and a decline in kidney function. Usually, adjustment of other oral glucose lowering drugs or diuretics is not necessary, but sometimes this is useful. Diabetic persons taking SGLT2 inhibitors should be careful during periods of severe illness, dehydration, or if they stop their insulin, as this has been linked to diabetic ketoacidosis, with high levels of glucose, which is a serious medical condition requiring prompt medical treatment.

Top tips: SGLT2 inhibitors can be safely started or stopped with gradual increase or decrease of the dose. Usually, the starting dose is also the maximum dose.