Impact of SGLT2 Inhibitors in the Management of Diabetes and Heart Failure Comorbidity: A Review of Current Evidence

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have emerged as a novel class of medication for managing both type 2 diabetes mellitus and heart failure (HF), offering significant cardioprotective benefits beyond glycemic control. This study reviewed current findings on the efficacy of SGLT2 inhibitors as a therapeutic approach for managing diabetes and HF comorbidity. Based on reports from clinical trials on empagliflozin, dapagliflozin, canagliflozin, sotagliflozin, and ertugliflozin, the review revealed that SGLT2 inhibitors demonstrated superior efficacy compared to placebo for managing HF and reducing the risk of major adverse cardiovascular events in patients with and without diabetes mellitus. However, higher incidences of adverse effects such as diarrhea, amputation, hypoglycemia, genitourinary infections, and diabetic ketoacidosis were reported in patients who received SGLT2 inhibitors. Most of the trials represent the initial studies undertaken for each of the drugs, and their findings informed regulatory approvals for HF management and reduction of cardiovascular events. While most of the studies focused on assessing the clinical outcomes, a few mechanistic studies were undertaken, which revealed that the reported cardiovascular outcomes of SGLT2 inhibitors could be due to the promotion of reverse cardiac remodeling. Furthermore, only a few of the studies compared the clinical efficacy of SGLT2 inhibitors with that of other classes of hypoglycemic agents. This review highlighted research directions that can contribute to a more comprehensive understanding of SGLT2 inhibitor safety and efficacy, ensuring optimal utilization in diverse patient populations.