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The Management of Patients with Heart Failure and Diabetes
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Building upon the previous trials, results from the DAPA-HF trial suggest that SGLT2 inhibitors may benefit non-diabetic HF patients.37 DAPA-HF randomized 4,744 patients with HF with reduced ejection fraction, of whom 42% were diabetic, to dapagliflozin 10 mg daily or placebo. The primary endpoint was a composite of hospitalization for heart failure or need for intravenous diuretics and cardiovascular death. The primary outcome occurred in 16.3% of the dapagliflozin group and 21.2% of the placebo group with an HR 0.74 (95% CI 0.65–0.85; P<0.001). Findings were similar in patients with and without diabetes. Dapagliflozin was also associated with reduction in the secondary endpoints of worsening heart failure, death from cardiovascular death, and all-cause death.
Endocrine Disorders, Contraception, and Hormone Therapy during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Eight first trimester pregnancies were exposed to dapagliflozin. Outcomes included six birth defects: one renal aplasia, one esophageal atresia, one hydrocephaly, two cases of encephalocele, and talipes (Benhalima et al., 2018).
Congestive Heart Failure
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Long-term management for HF is achieved with diuretics, nitrates, digoxin, ACE inhibitors, beta-blockers, aldosterone antagonists, ARBs, and angiotensin receptor/neprilysin inhibitors. If the sodium-glucose co-transporter 2 inhibitor called dapagliflozin is added, it can reduce complications and deaths if the patient has elevated natriuretic peptide levels. It has good effects in patients with diabetes mellitus or without. For arrhythmias, electrolytes are normalized, atrial and ventricular rates are controlled, and antiarrhythmic medications may be administered. For persistent sinus tachycardia, a beta-blocker given in increasing doses may be helpful. Atrial fibrillation with an uncontrolled ventricular rate is treated with a target resting rate being less than 80 beats per minute. Beta-blockers are used first, but rate-limiting calcium channel blockers are used with caution as long as systolic function is preserved. For some patients, digoxin is used to control heart rhythm or rate. A permanent pacemaker must be inserted for some patient.
Sodium-glucose transporter (SGLT2) inhibition: A potential target for treatment of type-2 Diabetes Mellitus with Natural and Synthetic compounds
Published in Egyptian Journal of Basic and Applied Sciences, 2023
Shubham Batra, Prabhjeet Kaur Bamrah, Manjusha Choudhary
Dapagliflozin, a highly potent and specific SGLT2 inhibitor, was approved by the FDA in 2014 and is used to treat T2DM throughout the world, including in the EU and the US. It is 1400 times more selective for SGLT2 than SGLT1. Recent studies have shown that dapagliflozin induces osmotic diuresis, reduces blood pressure and body weight without increasing heart rate, and therefore it may have a valuable effect on heart failure patients [17]. As an addition to insulin, dapagliflozin demonstrated good safety and tolerability and resulted in dose-related increases in urine glucose excretion, decreases in 24-hour mean glucose, and declines in glucose variability [18]. Higher research is required to determine the effectiveness, safety, and efficacy of dapagliflozin, which exhibited side effects like hypotension, dehydration, vaginal infections, and renal impairment [19].
Insights into efficacy and safety of dapagliflozin treatment for the management in older adults with type 2 diabetes: a systematic review and meta-analysis
Published in Expert Opinion on Drug Safety, 2023
Lili Jiang, Yanyan Jia, Xiaoyu Wang, Zhe Wang, Xin Lv, Yaqin Jia, Yuyi Feng, Hang Yin, Mingrui Yan, Xiaoyu Fan, Yong Liu
Previous studies have showed the efficacy and safety of dapagliflozin combined with other antihyperglycemic agents in type 2 diabetes [11,12]. Moreover, some systematic reviews in older adults with diabetes have focused on combination drugs class or comparing dapagliflozin with other diabetic agents [13–16] and assessed solely outcome of cardiovascular events such as heart failure [17,18]. However, scientific or systematic reviews about dapagliflozin as monotherapy for type 2 diabetes are scarce. In addition, the efficacy and safety of dapagliflozin in older adults with diabetes have yet to be fully explored [9,17]. Therefore, the aim of this study was to systematically assess the efficacy and safety of dapagliflozin as a monotherapy in the treatment of older adults with diabetes and provide theoretical basis for clinical rational use of drugs in the elderly people. In the present study, we sought to assess the potential efficacy and safety of dapagliflozin versus placebo, based on published and unpublished randomized trials of older patients with type 2 diabetes (>60 years of age).
Dapagliflozin cost-effectiveness analysis in heart failure patients in Egypt
Published in Journal of Medical Economics, 2022
Magdy Abdelhamid, Gihan Hamdy Elsisi, Ahmed Seyam, Ahmed Shafie, Mary Kirollos, Sandy Emad, Shady Mansy, Mohamed Sobhy
Dapagliflozin is an innovative SGLT2i used for the treatment of type 2 diabetes and was recently approved by the Food and Drug Administration for the treatment of HF-rEF in adults16. It had better efficacy compared to the placebo as an add-on to the SOC. In the DAPA-HF trial, dapagliflozin was associated with better outcomes in HF-rEF, which reduced the risk of HF-related mortality and HF hospitalizations13. Our results demonstrated that dapagliflozin is highly cost-effective and is a good value compared to the SOC due to fewer hospitalizations and lower mortality, in addition to cost-savings compared to sacubitril/valsartan. Furthermore, dapagliflozin improved tolerance in patients from different age groups17. Besides clinical benefits, dapagliflozin also had significant benefits for patients’ physical function and quality of life18. Importantly, dapagliflozin increased the number of patients with improved health status18.