Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are underused in patients with type 2 diabetes mellitus (T2DM) and heart failure (HF) despite their benefit, according to a study which appeared in Cardiovascular Drugs and Therapy.

“The benefit of SGLT2i in patients with HF with reduced ejection fraction (HFrEF) and T2DM has been unequivocally proven in randomized, controlled trials,” the researchers wrote. “However, real-world evidence assessing the implementation of SGLT2i in clinical practice and their benefit in HF outside of highly selected study populations is limited.”

This study comprised 812 patients with HF and T2DM who were admitted between January 2014 and April 2020. Researchers assessed first-time prescriptions of SGLT2i. The primary endpoint was cardiovascular mortality.

According to the results of the study, SGLT2i treatment was associated with long-term cardiovascular survival in patients with HFrEF presenting with an adjusted HR of 0.33 (95% confidence interval, 0.13-0.86). Despite this benefit, only 17.3% of patients received a prescription for an SGLT2i. Prescriptions for SGLT2i increased by 36.6% over the analysis period (P < 0.001).

Despite large outcome trials showing a cardiovascular benefit, SGLT2i remain underutilized in clinical practice in patients with T2DM and HF. National and European Medical Agency remuneration regulations would allow more patients at high risk to receive these cardiovascular protective drugs,” the researchers concluded. They added that “an SGLT2i therapy was associated with a survival benefit in patients with HFrEF.”

Keywords: Diabetes mellitus, Heart failure, Prescription patterns, SGLT2i