Effects of SGLT2 Inhibitors on the Risks of Hypertension and Heart Failure in Diabetic Patients: A Systematic Review

2021 ◽  
Vol 1 ◽  
pp. 73-80
Author(s):  
Harzhin Hiwa Ali ◽  
Naza Mohammed Ali Mahmood ◽  
Saad Abdulrahman Hussain
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Blood Sugar ◽  
Animal Studies ◽  
Cardiovascular Effects ◽  
Pressure Control ◽  
Sglt2 Inhibitors ◽  
Diabetic Patients ◽  
Good Glycemic Control ◽  
Artery Disease

Diabetes mellitus (DM) with uncontrolled blood sugar causes a variety of problems, including coronary artery disease, stroke, heart failure, hypertension, nephropathy, neuropathy, and retinopathy. These consequences harm the diabetic patients' lives. Many studies have shown that diabetic patients have a higher rate of heart failure and a worse prognosis than non-diabetic people. Sodium and glucose co-transporter receptor-2 (SGLT2) inhibitors are a relatively new class of anti-diabetic drugs. They not only regulate blood sugar but also have positive cardiovascular effects via a variety of mechanisms. This review intends to show that SGLT2 inhibitors, in addition to good glycemic control, possess a cardioprotective role. We conducted a literature review and identified 20 adequately powered clinical trials and animal studies in type 2 DM that investigated the cardiovascular (CV) effects of SGLT2 inhibitors (particularly heart failure and hypertension). These studies looked at the cardiovascular effects of three SGLT2 inhibitors: Empagliflozin, Canagliflozin, and Dapagliflozin. In diabetic patients, these three inhibitors of SGLT2 significantly lowered the risk of heart failure and hypertension, making them valuable therapy for lowering CV risks in high cardiovascular-risk individuals with T2DM. Finally, the use of SGLT2 inhibitors in patients without diabetes mellitus showed positive metabolic outcomes in weight and blood pressure control.

scholarly journals Diabetes Mellitus and Heart Failure

2021 ◽  
Vol 10 (16) ◽  
pp. 3682
Author(s):  
Filippos Triposkiadis ◽  
Andrew Xanthopoulos ◽  
Alexandra Bargiota ◽  
Takeshi Kitai ◽  
Niki Katsiki ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Cardiovascular Effects ◽  
Sodium Glucose Cotransporter ◽  
Rigorous Treatment ◽  
Resistance To Insulin ◽  
Artery Disease ◽  
Type 1 Dm ◽  
New Onset

Diabetes mellitus (DM) is a major risk factor for new-onset heart failure (HF) and vice versa. The pathogenesis of new-onset HF in DM is complex and has been largely attributed to the toxic cardiovascular effects of hyperglycemia and relevant metabolic abnormalities (diabetic cardiomyopathy) as well as the frequently coexisting morbidities such as hypertension (HTN), coronary artery disease (CAD), and diabetic nephropathy. In patients with type 1 DM (T1DM), HF develops in the setting of a dysregulated immune response, whereas in most patients with type 2 DM (T2DM), against a background of overweight/obesity. HF prevention in DM is feasible with rigorous treatment of cardiovascular risk factors and selective antidiabetic agents. Conversely, development of new-onset T2DM in HF (cardiogenic DM) is common and has been attributed to an increase in the resistance to insulin, especially in the skeletal muscle, liver, and adipose tissue as well as in diminished insulin secretory response to hyperglycemia by pancreatic β-cells. Cardiogenic DM further deteriorates cardiac dysfunction and adversely affects outcome in HF. Novel lifesaving medications employed in HF management such as sacubitril/valsartan and sodium glucose cotransporter 2 inhibitors (SGLT-2i) have a favorable metabolic profile and lower the incidence of cardiogenic diabetes. Whether mitigation of cardiogenic DM should be a treatment target in HF deserves further investigation.

scholarly journals Renal and Cardiovascular Effects of sodium–glucose cotransporter 2 (SGLT2) inhibition in combination with loop Diuretics in diabetic patients with Chronic Heart Failure (RECEDE-CHF): protocol for a randomised controlled double-blind cross-over trial

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e018097 ◽  
Author(s):  
Natalie A Mordi ◽  
Ify R Mordi ◽  
Jagdeep S Singh ◽  
Fatima Baig ◽  
Anna-Maria Choy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Effects ◽  
Sglt2 Inhibitors ◽  
Loop Diuretics ◽  
Diabetic Patients ◽  
Creatinine Ratio ◽  
Double Blind ◽  
Sodium Glucose Cotransporter ◽  
Sglt2 Inhibition ◽  
Secondary Outcomes

IntroductionType 2 diabetes (T2D) and heart failure (HF) are a frequent combination, where treatment options remain limited. There has been increasing interest around the sodium–glucose cotransporter 2 (SGLT2) inhibitors and their use in patients with HF. Data on the effect of SGLT2 inhibitor use with diuretics are limited. We hypothesise that SGLT2 inhibition may augment the effects of loop diuretics and the benefits of SGLT2 inhibitors may extend beyond those of their metabolic (glycaemic parameters and weight loss) and haemodynamic parameters. The effects of SGLT2 inhibitors as an osmotic diuretic and on natriuresis may underlie the cardiovascular and renal benefits demonstrated in the recent EMPA-REG study.Methods and analysisTo assess the effect of SGLT2 inhibitors when used in combination with a loop diuretic, the RECEDE-CHF (Renal and Cardiovascular Effects of SGLT2 inhibition in combination with loop Diuretics in diabetic patients with Chronic Heart Failure) trial is a single-centre, randomised, double-blind, placebo-controlled, cross-over trial conducted in a secondary care setting within NHS Tayside, Scotland. 34 eligible participants, aged between 18 and 80 years, with stable T2D and CHF will be recruited. Renal physiological testing will be performed at two points (week 1 and week 6) on each arm to assess the effect of 25 mg empagliflozin, on the primary and secondary outcomes. Participants will be enrolled in the trial for a total period between 14 and 16 weeks. The primary outcome will assess the effect of empagliflozin versus placebo on urine output. The secondary outcomes are to assess the effect of empagliflozin on glomerular filtration rate, cystatin C, urinary sodium excretion, urinary protein/creatinine ratio and urinary albumin/creatinine ratio when compared with placebo.Ethics and disseminationEthics approval was obtained by the East of Scotland Research Ethics Service. Results of the trial will be submitted for publication in a peer-reviewed journal.Trial registration numberNCT03226457; Pre-results.

scholarly journals Assessment of cardiac complication in diabetic patient of rural India

2020 ◽  
Vol 8 (8) ◽  
pp. 2958
Author(s):  
E. Ahmad ◽  
A. Singh ◽  
R. R. Chaudhary ◽  
M. S. Sarda
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Myocardial Ischemia ◽  
Diabetic Patient ◽  
Cardiac Complication ◽  
Silent Myocardial Ischemia ◽  
Rural India ◽  
Diabetic Patients ◽  
Artery Disease

Background: Diabetes mellitus (DM) is a common endocrine disorder affecting approximately 382 million people worldwide. Diabetes mellitus (DM) is group of metabolic disorder in which glucose is underutilized, thus producing hyperglycemia resulting from a defect in insulin secretion, action, or both. Cardiovascular disease is the most common cause of death and disability among people with diabetes. The cardiovascular disease that accompany diabetes include angina, myocardial infarction (heart attack), Stroke, peripheral artery disease and congestive heart failure. In people with diabetes, high blood pressure, high cholesterol, high blood glucose and other risk factors contribute to the increased risk of cardiovascular complications.Method:  This study was conducted to determine the cardiac complication in diabetic patient of rural India. It was Cross sectional retrospective study, done in between period of January 2018 to December 2019.Result: In the present study authors found that   47.7% patients have Coronary artery disease (CAD), Silent 21.6% have myocardial ischemia (SMI), 36% Diastolic dysfunction (DF), 28.8% have Systolic dysfunction (SDF).Conclusion: In this study authors found that wide spectrum of cardiac complications in diabetic patients ranging silent myocardial ischemia to heart failure. CAD was the most common complication including silent myocardial ischemia (SMI) which is the one of the major concern of rural diabetic population which need proper screening by exercise treadmill test.

scholarly journals The effects of antidiabetic agents on heart failure

2021 ◽  
Author(s):  
M. Wijnen ◽  
E. J. J. Duschek ◽  
H. Boom ◽  
M. van Vliet
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Ejection Fraction ◽  
Diabetes Mellitus Type 2 ◽  
Sglt2 Inhibitors ◽  
Diabetes Mellitus Type ◽  
Diabetic Patients ◽  
Antidiabetic Agents ◽  
Dipeptidyl Peptidase 4 Inhibitors

AbstractIn the Netherlands, approximately 250,000 people are living with heart failure. About one-third of them have comorbid diabetes mellitus type 2. Until recently, the effects of antidiabetic agents on heart failure were largely unknown. This changed after an observed increased risk of heart failure and ischaemic heart disease associated with thiazolidinediones that prompted the requirement for cardiovascular outcome trials for new glucose-lowering drugs. In the past decade, three new classes of antidiabetic agents have become available (i.e. dipeptidyl peptidase‑4 inhibitors, glucagon-like peptide‑1 receptor agonists and sodium-glucose cotransporter‑2 (SGLT2) inhibitors). Although the first two classes demonstrated no beneficial effects on heart failure compared to placebo in patients with diabetes mellitus type 2, SGLT2 inhibitors significantly and consistently lowered the risk of incident and worsening heart failure. Two recent trials indicated that these favourable effects were also present in non-diabetic patients with heart failure with reduced ejection fraction, resulting in significantly lower risks of hospitalisation for heart failure and presumably also cardiovascular and all-cause mortality. SGLT2 inhibitors have been shown to be benefit on top of recommended heart failure therapy including sacubitril/valsartan and may also prove beneficial for heart failure with preserved ejection fraction. In this review, we discuss the effects of antidiabetic agents on heart failure.

Sodium-glucose co-transporter 2 inhibitors and cardiovascular outcomes: A systematic review and meta-analysis

2018 ◽  
Vol 25 (5) ◽  
pp. 495-502 ◽  
Author(s):  
Muhammad Shariq Usman ◽  
Tariq Jamal Siddiqi ◽  
Muhammad Mustafa Memon ◽  
Muhammad Shahzeb Khan ◽  
Wasiq Faraz Rawasia ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Meta Analysis ◽  
Cardiovascular Effects ◽  
Sglt2 Inhibitors ◽  
Cardiac Events ◽  
Adverse Cardiac Events

Background The risks and benefits of sodium-glucose co-transporter 2 (SGLT2) inhibitors on cardiovascular outcomes have not been well established. We pooled evidence from all available clinical trials to assess the cardiovascular effects of this drug. Design A systematic review and meta-analysis of randomised controlled trials. Methods We queried electronic databases (MEDLINE, Scopus, CENTRAL and clinicaltrials.gov) from their inception to July 2017 for published and unpublished placebo controlled trials of SGLT2 inhibitors. Only studies with a follow-up period of at least 24 weeks and reporting at least one cardiovascular outcome were included. Results from trials were presented as odds ratios (ORs) with 95% confidence intervals (CIs) and were pooled using a random-effects model. Results Thirty-five eligible studies (canagliflozin, nine; empagliflozin, eight; dapagliflozin, 18), consisting of 34,987 patients with type 2 diabetes mellitus were included. Pooled results show that SGLT2 inhibitors, when compared to placebo, significantly reduce all-cause mortality (OR 0.79, 95% CI 0.70–0.89; P < 0.001), major adverse cardiac events (OR 0.8, 95% CI 0.76–0.92; P < 0.001), non-fatal myocardial infarction (OR 0.85, 95% CI 0.73–0.98; P = 0.03) and heart failure/hospitalisation for heart failure (OR 0.67, 95% CI 0.59–0.76; P < 0.001) in patients with type 2 diabetes mellitus. No significant difference was noted in the occurrence of stroke (OR 1.02, 95% CI 0.85–1.21; P = 0.87), atrial fibrillation (OR 0.61, 95% CI 0.31–1.19; P = 0.15) or unstable angina (OR 0.95, 95% CI 0.73–1.25; P = 0.73). In addition, there was no heterogeneity between different drugs in the SGLT2 inhibitor class for all of the clinical outcomes studied ( I2 = 0). Conclusions SGLT2 inhibitors significantly reduce the incidence of mortality, major adverse cardiac events, non-fatal myocardial infarction and heart failure in patients with type 2 diabetes mellitus. Subtypes of SGLT2 inhibitors appear to have similar cardiovascular effects.

Poor outcome of diabetic patients with coronary artery disease and coexisting heart failure

2008 ◽  
Vol 7 ◽  
pp. 19-19
Author(s):  
B PONIKOWSKA ◽  
E JANKOWSKA ◽  
K WEGRZYNOWSKATEODORCZYK ◽  
S POWIERZA ◽  
L BORODULINNADZIEJA ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Diabetic Patients ◽  
Poor Outcome ◽  
Artery Disease

ESTIMATION OF SERUM FERRITIN LEVELS IN TYPE 2 DIABETIC PATIENTS AND ITS RELATION WITH HbA1C LEVEL.

2019 ◽  
Vol 3 (8) ◽  
Author(s):  
Shah Namrata Vinubhai ◽  
Pardeep Agarwal ◽  
Bushra Fiza ◽  
Ramkishan Jat
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Blood Sugar ◽  
Serum Ferritin ◽  
Inflammatory Marker ◽  
Control Group ◽  
Diabetic Patients ◽  
Positive Correlation

Background: Serum ferritin is known as an index for body iron stores also as an inflammatory marker and it is influenced by several disease. We were looking for a correlation between HbA1c and S. Ferritin in type 2 DM. Methodology: The present study a total of 150 participants were enrolled of which 100 were confirmed cases of Type 2 Diabetes Mellitus and rest 50 age and sex matched healthy subjects constituted the control group. All were screened for HbA1c, Fasting blood sugar, Post prandial blood sugar and S.Ferritin. Results: A highly significant variation and positive correlation was observed with respect to S.Ferritin and HbA1c levels. Mean S.Ferritin was high in the subgroup with poor glycemic control. Conclusion: The fasting, post prandial sugar levels, HbA1c and S.Ferritin were significantly higher in the diabetic subjects. This study shows a positive correlation between HbA1c and S. Ferritin levels. So we can conclude that in diabetic patients S. Ferritin may serve as an independent marker of poor glycemic and metabolic control. Keywords: Serum ferritin, Type 2 Diabetes Mellitus, HbA1c.

Mechanisms of Protective Effects of SGLT2 Inhibitors in Cardiovascular Disease and Renal Dysfunction

2019 ◽  
Vol 19 (20) ◽  
pp. 1818-1849 ◽  
Author(s):  
Ban Liu ◽  
Yuliang Wang ◽  
Yangyang Zhang ◽  
Biao Yan
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Renal Dysfunction ◽  
Sglt2 Inhibitors ◽  
Sodium Glucose Cotransporter ◽  
Glucose Reabsorption ◽  
Renal Glucose Reabsorption

: Type 2 diabetes mellitus is one of the most common forms of the disease worldwide. Hyperglycemia and insulin resistance play key roles in type 2 diabetes mellitus. Renal glucose reabsorption is an essential feature in glycaemic control. Kidneys filter 160 g of glucose daily in healthy subjects under euglycaemic conditions. The expanding epidemic of diabetes leads to a prevalence of diabetes-related cardiovascular disorders, in particular, heart failure and renal dysfunction. Cellular glucose uptake is a fundamental process for homeostasis, growth, and metabolism. In humans, three families of glucose transporters have been identified, including the glucose facilitators GLUTs, the sodium-glucose cotransporter SGLTs, and the recently identified SWEETs. Structures of the major isoforms of all three families were studied. Sodium-glucose cotransporter (SGLT2) provides most of the capacity for renal glucose reabsorption in the early proximal tubule. A number of cardiovascular outcome trials in patients with type 2 diabetes have been studied with SGLT2 inhibitors reducing cardiovascular morbidity and mortality. : The current review article summarises these aspects and discusses possible mechanisms with SGLT2 inhibitors in protecting heart failure and renal dysfunction in diabetic patients. Through glucosuria, SGLT2 inhibitors reduce body weight and body fat, and shift substrate utilisation from carbohydrates to lipids and, possibly, ketone bodies. These pleiotropic effects of SGLT2 inhibitors are likely to have contributed to the results of the EMPA-REG OUTCOME trial in which the SGLT2 inhibitor, empagliflozin, slowed down the progression of chronic kidney disease and reduced major adverse cardiovascular events in high-risk individuals with type 2 diabetes. This review discusses the role of SGLT2 in the physiology and pathophysiology of renal glucose reabsorption and outlines the unexpected logic of inhibiting SGLT2 in the diabetic kidney.

Evaluation of the alterations in the serum blood sugar level, the activity of AST and ALT enzymes of diabetes mellitus type 2 in Iraqi women patients

2021 ◽  
Vol 16 (8) ◽  
pp. 98-102
Author(s):  
Hashim Abdul Razzaq Iman ◽  
Hussein Murtadha Jinan
Keyword(s):  
Diabetes Mellitus ◽  
Blood Sugar ◽  
Diabetes Mellitus Type 2 ◽  
Correlation Factor ◽  
Diabetes Mellitus Type ◽  
Fasting Blood Sugar ◽  
Diabetic Patients ◽  
Cell Dysfunction ◽  
Iraqi Women

Diabetes mellitus type 2 (T2DM) results from beta cell dysfunction or reduced action of insulin responsive. The objective of this study was to examine the relevance between blood sugar, the activity of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in fasting women diabetic patients in different durations. A total of sixty-eight women were divided into three groups: first a healthy group – non-diabetic (twenty-six women), second and third groups (twenty-one) were diabetic patients of age 35 – 50 and 51 – 69 years respectively. Serum fasting blood sugar was significantly (P < 0.05) elevated to 181.60 mg/dl in female patients with 35 – 50 years. The same effect happened in activity of AST to 32.91 u/L in 51 – 69 years and ALT was 28.43 u/L in 35 – 50 years. No significant differences were found between the aged and fasting blood sugar, AST and ALT in diabetic patients. The correlation factor (r) between fasting blood sugar and the activity of ALT was highly significant.

Current state-of-the-art antiplatelet and anticoagulation therapy in diabetic patients with coronary artery disease

2021 ◽  
Author(s):  
Johny Nicolas ◽  
Victor Razuk ◽  
Gennaro Giustino ◽  
Roxana Mehran
Keyword(s):  
Diabetes Mellitus ◽  
Complex Disease ◽  
Anticoagulation Therapy ◽  
Treatment Strategies ◽  
Diabetic Patients ◽  
Current State ◽  
Organ Systems ◽  
Patients With Diabetes ◽  
The Status ◽  
Artery Disease

Diabetes mellitus is a complex disease that leads to long-term damage to various organ systems. Among the numerous cardiovascular disease-related complications, thrombotic events frequently occur in patients with diabetes. Although guidelines exist for treating and preventing most diabetes-related co-morbidities, the evidence on antithrombotic therapy in primary and secondary prevention is limited due to the scarcity of randomized trials dedicated to patients with diabetes mellitus. Most of the available data are derived from studies that only included a small proportion of patients with diabetes. The present review provides an overview of the status of knowledge on antiplatelet and anticoagulation therapy in patients with diabetes, focusing on the risk–benefit balance of these therapies and future treatment strategies.

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