Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors and Risk of Heart Failure Hospitalization in Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Abstract
Sodium-glucose cotransporter-2 (SGLT2) inhibitors have emerged as a transformative therapy in type 2 diabetes mellitus (T2DM), offering benefits that extend beyond glycemic control. We conducted a meta-analysis of six large randomized controlled trials (RCTs), enrolling more than 47,000 patients with T2DM and varying risks of cardiovascular disease (CVD) and chronic kidney disease (CKD), to evaluate the effect of SGLT2 inhibitors on hospitalization for heart failure (HHF). Across a mean follow-up ranging from 1.3 to 4.2 years, SGLT2 inhibitors were associated with a 28% relative risk reduction in HHF compared with placebo or standard care. This benefit was consistent across most agents, including empagliflozin, canagliflozin, dapagliflozin, and sotagliflozin, while ertugliflozin showed a nonsignificant trend in the same direction. Subgroup analyses confirmed benefits in patients with established atherosclerotic CVD as well as those with CKD, underscoring the broad applicability of this therapy. The results demonstrate that SGLT2 inhibitors confer clinically meaningful cardiorenal protection that is recognized to occur through mechanisms largely independent of glucose lowering, reinforcing their role as cornerstone agents in the management of T2DM. These findings highlight the importance of prioritizing SGLT2 inhibitors in contemporary diabetes care to reduce the global burden of heart failure (HF).
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 47,000 participants or records.
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