Comparative study of heart failure patients on sglt2 inhibitors (dapagliflozin) in diabetes and non-diabetes groups

Type 2 diabetes mellitus increases the risk of heart failure (HF) development, morbidity, and mortality. Mechanisms include altered myocardial substrates, mitochondrial bioenergetics, lipotoxicity, oxidative stress, advanced glycation end products, and signaling pathway changes. Sodium–glucose cotransporter-2 (SGLT-2) inhibitors, such as dapagliflozin, have shown cardiovascular benefits. Trials like DAPA-HF and EMPEROR demonstrated reductions in cardiovascular death and HF hospitalizations, but effects on diabetic versus non-diabetic HF patients remain unexplored. This is a prospective comparative cohort study was conducted from September 2022 to December 2023 at Aster CMI Hospital, Bangalore, involving 130 HF patients. The mean age was 65.35 ± 10.66 years for diabetics and 60.89 ± 7.86 years for non-diabetics. Patients were divided into two groups based on diabetic status and received dapagliflozin 10mg. Baseline characteristics included mean BMI (29.77±5.8 for diabetics, 29.90±5.9 for non-diabetics) and mean LVEF (40.40 ± 8.09 for diabetics, 44.67 ± 3.49 for non-diabetics). The primary outcome, a composite of HF hospitalization, cardiovascular events, and mortality, was assessed over 12 months. Hospitalization rates decreased from 2.43±1.29 to 0.50±0.81 in diabetics and from 2.06±1.01 to 0.47±0.72 in non-diabetics. Dapagliflozin showed similar cardiovascular outcomes in both diabetic and non-diabetic HF patients, significantly reducing HF hospitalizations and improving cardiac function, regardless of ejection fraction. Adverse effects were minimal. The findings suggest dapagliflozin's potential in enhancing myocardial function and prognosis in HF, beyond glucose control. Further research is needed to explore its use in acute HF decompensation scenarios.