The End of Diabetes: The Eat to Live Plan to Prevent and Reverse Diabetes

A new guideline issued by major American heart health authorities has recommended an important diabetes drug for the treatment of a form of heart failure.

SGLT-2 inhibitors, a class of drugs used as a glucose-lowering medication for type 2 diabetes, were officially validated as an effective treatment for heart failure with lowered ejection fraction, a condition which indicates that the heart is unable to pump out enough blood. Biykem Bozkurt, MD, PhD, one of the co-authors, stated that these drugs showed a “30% reduction in heart failure rehospitalization.”

The new guideline was signed by the American College of Cardiology, the American Heart Association, and the Heart Failure Society of America. In a long and comprehensive update, the authors listed the new indication for SLGT-2 inhibitors as the number one “take-home message.”

The evidence in favor of the new use is very strong. The guideline referred to large studies of three SGLT-2 inhibitors, showing that canagliflozin, dapagliflozin, and empagliflozin each reduced the frequency of cardiovascular events in patients with type 2 diabetes with an elevated peril of heart illness. Other trials demonstrated similar positive consequences for participants with cardiovascular risks but without diabetes.

The new guidelines ought to be of special interest to patients with type 2 diabetes. folks with diabetes are at a significantly enhanced risk of heart disease and heart failure.

Heart failure with reduced ejection fraction affects more than 10 million people worldwide, and can be extremely dangerous. A 2020 review found that patients hospitalized with the condition have a 5-year survival rate of only 25%. The new guidance suggests that SGLT-2 inhibitors should also be considered in less acute cases of heart failure, such as patients with “mildly reduced” or “preserved” ejection fraction. More details on the new recommendations can be found in the American Heart Association’s official press release.

SGLT-2 Inhibitors & Diabetes

Today, SGLT-2 inhibitors are primarily prescribed to patients with type 2 diabetes. These pills alleviate diabetes by preventing the body from re-absorbing sugar in the kidneys. Some excess sugar is instead flushed out with the urine, lowering blood glucose levels.

For patients with diabetes, protection from heart failure is just one more major potential benefit for SGLT-2 inhibitors. Drugs in this class are also known to promote modest weight loss and reduce high blood pressure. And in late March, a trial evaluating whether or not Jardiance (empagliflozin) could prevent and treat kidney disease was stopped early because the results were overwhelmingly positive.

SGLT-2 inhibitors can be very expensive, and are typically considered only a second option for patients that have difficulty meeting glucose control targets with metformin, especially those with elevated cardiovascular risk factors. But given the wealth of apparent benefits to patients, some experts have suggested that SGLT-2 inhibitors should replace metformin as the first-line therapy for type 2 diabetes.

There are currently four SGLT-2 inhibitors available in the United States:

• canagliflozin (Invokana)
• dapagliflozin (Farxiga)
• empagliflozin (Jardiance)
• ertugliflozin (Steglatro)

Some are also available in combination with other diabetes medications, such as metformin. SGLT-2 medications are taken as a pill, typically daily.

Although SGLT-2 inhibitors are sometimes prescribed off-label for people with type 1 diabetes, doctors and patients have been urged to use “extreme caution,” because the drug is known to carry a significant risk of diabetic ketoacidosis (DKA). The FDA has thus far declined to approve drugs in this class for use in patients with type 1.

Diabetes Daily

The End of Diabetes: The Eat to Live Plan to Prevent and Reverse Diabetes