China
Africa
Explore chapters and articles related to this topic
Pathophysiology of Heart Failure with Reduced Ejection Fraction
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Jacob Cao, John O'Sullivan, Sean Lal
The cardioprotective benefits of SGLT2 inhibitors may not be limited to type 2 diabetes patients alone. In 2019, dapagliflozin was shown in a large, placebo-controlled, randomized trial (DAPA-HF) to reduce composite worsening HF and cardiovascular death by 26% over median 18 months follow-up.35 Notably, pre-specified subgroup analysis by type 2 diabetes status (nearly half of the patients in the dapagliflozin and placebo arms) demonstrated benefits in both those with and without type 2 diabetes. This has subsequently been confirmed by the EMPEROR-Reduced trial demonstrating a 31% reduction in heart failure hospitalization with empagliflozin compared to placebo regardless of diabetes status.36
Managing Diabetes and Prediabetes
Published in Ruth Chambers, Paula Stather, Tackling Obesity and Overweight Matters in Health and Social Care, 2022
The ideal drug to manage type 2 diabetes should encourage weight loss and not cause hypoglycaemia. Here are a few examples: Metformin. This low-cost drug has been available in the UK for over 60 years and remains the preferred first choice for newly diagnosed patients with type 2 diabetes.Glucagon-linked peptide (GLP) 1 analogue. These injections can be administered twice a day, once a day or once a week.Sodium glucose co-transporter 2(SGLT2) inhibitor works by preventing the kidneys from reabsorbing glucose back into the blood. Sulfonylureas and insulin commonly cause weight gain, and weight gain is a recognised side effect of pioglitazone. Dipeptidyl peptidase-4 (DPP4) inhibitors are weight neutral.
Selected topics
Published in Henry J. Woodford, Essential Geriatrics, 2022
Sodium-glucose co-transporter 2 (SGLT2) inhibitors reduce glucose reabsorption and increase urinary glucose excretion in the renal proximal tubules (e.g. dapagliflozin, empagliflozin and canagliflozin). HbA1C reduction is around 6–8 mmol/mol (0.5–0.7%).93 They are taken orally and are associated with weight loss and less frequent hypoglycaemia than insulin or sulphonylureas. SGLT2 inhibitors have some cardiovascular benefits. They have been shown to be beneficial for people, with and without diabetes, who have HFrEF (see page 364). In people with atherosclerotic disease, major cardiovascular events are lowered (mean age 63; HR 0.89; 95% CI 0.83–0.96) and there is reduced progression of renal disease.117 Potential adverse effects include mycotic infections, dehydration, hypotension, urinary tract infections, Fournier's gangrene and euglycemic diabetic ketoacidosis. They may also increase the risk of fractures.118 These are likely to make SGLT2 inhibitors unsuitable for most frail older people with type 2 diabetes.
Comparative safety of sodium-glucose co-transporter 2 inhibitors in elderly patients with type 2 diabetes mellitus and diabetic kidney disease: a systematic review and meta-analysis
Published in Renal Failure, 2023
Yi Liu, Chuan An, Peilong Liu, Fan Yang, Quanlin Zhao
Despite our rigorous methodology and careful selection of relevant papers, our research has many deficiencies. Fixed-effects model should be used only if it is reasonable to assume that all studies share the same, one common effect. A fixed-effects model is inappropriate if statistical heterogeneity exists between effect sizes. Fixed-effects models consider only sampling error, with larger weights for larger samples and smaller weights for smaller samples. Therefore, the effect size of a large sample size study is almost determinative for the final combined effect size [36]. We only included 14 studies with a total of 59874 patients. Some studies have only 18 weeks of follow-up, which may not be enough to detect the effect of SGLT2 inhibitors on eGFR. Some studies have small numbers of participants, and the results may be subject to error, leading to inaccurate analyses. There are many types of SGLT2 inhibitors, and we only included studies on dapagliflozin, canagliflozin, empagliflozin, ertugliflozin, sotagliflozin, and bexagliflozin. This does not accurately reflect the safety of all SGLT2 inhibitors.
Emerging sodium-glucose cotransporter-2 inhibitor therapies for managing heart failure in patients with chronic kidney disease
Published in Expert Opinion on Pharmacotherapy, 2023
Jeffrey Shi Kai Chan, Francesco Perone, Yasmin Bayatpoor, Gary Tse, Amer Harky
In terms of safety, a particularly important and infamous potential adverse effect of SGLT2 inhibitors is ketoacidosis, although it has been shown consistently to be uncommon, with reported incidence rates of 0.6–2.2 events per 1000 person-years [90]. SGLT2 inhibitors have been specifically reported to be associated with the occurrence of euglycaemic diabetic ketoacidosis, an even rarer condition [91]. The Food and Drug Administration labels of both dapagliflozin and empagliflozin recommended withholding these medications for at least three days prior to major surgeries and cautioned their use in the presence of other predisposing factors for ketoacidosis. Although no direct evidence specific to patients with both HF and CKD exists in this regard, CKD is likely to adversely affect acid-base homeostasis, and there does not seem to be any plausible mechanism in which the risks of ketoacidosis would be lower in these patients. It would thus be reasonable to adhere closely to the above recommendations, including temporary withholding of SGLT2 inhibitors in patients with HF and CKD during acute illnesses or other predisposing conditions until the acute physiological stress has subsided.
Pharmacological treatment options for heart failure with reduced ejection fraction: A 2022 update
Published in Expert Opinion on Pharmacotherapy, 2022
Kristian Hellenkamp, Kathleen Nolte, Stephan von Haehling
SGLT2 inhibitors were originally intended for the management and therapy of type 2 diabetes mellitus. Indeed, the ESC HF guidelines list more SGLTS2 inhibitors (canagliflozin, ertugliflozin, and sotagliflozin) than dapagliflozin and empagliflozin for the treatment of diabetes mellitus in patients at risk of cardiovascular events in order to prevent hospitalizations for worsening HF[4]. Only dapagliflozin and empagliflozin are recommended to be used in all patients with manifest HF, irrespective of the presence of diabetes. Moreover, different trials have shown a clear benefit in the management of HF. The EMPA-REG OUTCOME trial proved reduced HF hospitalizations and cardiovascular deaths in patients with type 2 diabetes and high cardiovascular risk, when they were treated with empagliflozin added to standard care, in contrast to placebo. EMPA-REG OUTCOME randomly assigned patients with type 2 diabetes to receive 10 mg, 25 mg of empagliflozin or placebo once daily. A total of 7,020 were treated and the trial was very positive in that it reduced the primary outcome of death from cardiovascular causes, non-fatal myocardial infarction, or non-fatal stroke. These benefits were consistent in patients with and without HF at baseline. However, the EMPA-REG OUTCOME trial was not a dedicated HF trial, and the history of HF was based on medical record review rather than on physical, laboratory, or imaging results[25].