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TYPE 2 DIABETES MELLITUS IN 2020

SGLT2 inhibitors in people with and without T2DM

Nature Reviews Endocrinology volume 17, pages 75–76 (2021)Cite this article

Subjects

Heart failure and chronic kidney disease are frequent causes of morbidity and mortality in people with type 2 diabetes mellitus. Cardiovascular outcome trials have confirmed benefits of sodium–glucose co-transporter 2 inhibitors on cardiovascular events, cardiovascular deaths, hospitalization for heart failure and renal outcomes. These benefits now extend to people with and without type 2 diabetes mellitus.

Key advances

  • Sodium–glucose co-transporter 2 inhibitors significantly reduce the risk of major cardiovascular events, cardiovascular death or hospitalization for heart failure and progression of chronic kidney disease in people with type 2 diabetes mellitus (T2DM) with or without atherosclerotic cardiovascular disease2.

  • Dapagliflozin and empagliflozin have shown significant beneficial effects on the composite outcome of worsening of heart failure or cardiovascular death in patients with New York Heart Association Class 2, 3 or 4 heart failure with or without T2DM3,5.

  • Dapagliflozin and empagliflozin significantly reduce hospitalization for heart failure, and dapagliflozin significantly reduces cardiovascular death irrespective of T2DM status3,5.

  • Dapagliflozin and empagliflozin have significant beneficial effects on renal outcomes in people with and without T2DM5,6.

Type 2 diabetes mellitus (T2DM) is a chronic cardiometabolic condition that is associated with a high prevalence of chronic kidney disease (CKD), cardiovascular disease and heart failure, all of which are intricately interlinked and are associated with mortality, morbidity, poor quality of life and increased health-care costs. In people with TD2M but without pre-existing cardiovascular and renal disease, new-onset heart failure and CKD are the most frequent complications and causes of mortality1.

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Fig. 1: Potential mechanisms of SGLT2is in cardiorenal protection.

References

  1. Birkeland, K. I. et al. Heart failure and chronic kidney disease manifestation and mortality risk associations in type 2 diabetes: A large multinational cohort study. Diabetes Obes. Metab. 22, 1607–1618 (2020).

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  2. Qiu, M. et al. SGLT2 inhibitors for prevention of cardiorenal events in people with type 2 diabetes without cardiorenal disease: A meta-analysis of large randomized trials and cohort studies. Pharmacol. Res. 161, 105175 (2020).

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  7. Zannad, F. et al. SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials. Lancet 396, 819–829 (2020).

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Acknowledgements

K.K. is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands (ARC EM) and the NIHR Leicester Biomedical Research Centre (BRC).

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  1. Diabetes Research Centre, University of Leicester, Leicester, UK

    Kamlesh Khunti

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  1. Kamlesh Khunti
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Correspondence to Kamlesh Khunti.

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Competing interests

K.K. has acted as a consultant, speaker or received grants for investigator-initiated studies for AstraZeneca, Bayer, Berlin-Chemie AG/Menarini Group, Boehringer Ingelheim, Janssen, Lilly, Merck Sharp & Dohme, Napp, Novartis, Novo Nordisk and Sanofi-Aventis.

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Khunti, K. SGLT2 inhibitors in people with and without T2DM. Nat Rev Endocrinol 17, 75–76 (2021). https://doi.org/10.1038/s41574-020-00453-2

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  • DOI: https://doi.org/10.1038/s41574-020-00453-2

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