Dual SGLT1/2 inhibition with sotagliflozin: a pharmaceutical breakthrough in heart failure management and cardiometabolic risk reduction

Heart failure remains a global health crisis with high morbidity and mortality. Sotagliflozin, a first-in-class dual sodium-glucose cotransporter 1 and 2 (SGLT1/2) inhibitor, offers a novel therapeutic approach. Its dual mechanism concurrently inhibits renal (SGLT2) and intestinal (SGLT1) glucose transporters, enhancing glycemic control and providing additive benefits in cardiovascular risk reduction, blood pressure, and body weight management. Recent randomized trials demonstrate that sotagliflozin significantly lowers the risk of major cardiovascular events, heart failure hospitalizations, and all-cause mortality in patients with and without diabetes. While its safety profile is generally favorable, it necessitates monitoring for gastrointestinal effects and diabetic ketoacidosis. This review synthesizes mechanistic insights, clinical evidence, and practical considerations for integrating sotagliflozin into heart failure management, positioning it as a promising innovation in cardiometabolic therapeutics.