Dapagliflozin and DAPA‐HF: from glycaemic control to heart failure therapy
Abstract
192 PRACTICAL DIABETES Vol. 36 No. 6 Copyright © 2019 John Wiley & Sons S inhibitors are now firmly established as a therapy for glycaemic control in people with type 2 diabetes. Cardiovascular outcome trials with empagliflozin, canagliflozin and dapagliflozin have demonstrated reductions in major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke)1–3 and hospitalisation for heart failure.4–6 A dedicated renal outcomes trial with canagliflozin in patients with diabetic kidney disease has demonstrated a reduction in the risk of kidney failure.7 A consensus report from the ADA and EASD has recommended that SGLT2 inhibitors should be considered as second-line therapy after metformin in patients where heart failure or chronic kidney disease predominates.8 A recent European Society of Cardiology guideline developed in collaboration with the EASD has gone a step further and recommends that evidence-based SGLT2 inhibitors or GLP-1 receptor agonists should be used in patients with diabetes and prevalent cardiovascular disease whether they are treatment naïve or already on metformin (i.e. first-line or second-line).9 SGLT2 inhibitors are preferred for the patient with heart failure. In the UK, NICE has finally woken up to the extensive evidence base for reductions of cardiovascular and renal events with SGLT2 inhibitors (and GLP-1 receptor agonists) and a new guideline on the management of hyperglycaemia in people with type 2…
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