Prescribing a SGLT2 inhibitor for treating heart failure without inducing hypoglycaemia
Abstract
Sodium-glucose cotransporter type 2 inhibitors (SGLT2i or gliflozins) improve the prognosis of patients with heart failure, independently of the presence of diabetes. They are now recommended for the treatment of heart failure in international guidelines. The addition of a gliflozin driven by such a cardiological indication may require some adjustment of the antidiabetic therapy. The aim of this concise article is to discuss the potential risk of hypoglycaemia, highly deleterious in fragile patients at risk, following the prescription of a gliflozin in patients with heart failure. Different clinical situations will be considered, both in nondiabetic patients and in patients with type 2 diabetes already treated with a variety of antihyperglycaemic agents, metformin, sulphonylureas, gliptins, GLP-1 receptor agonists and insulin.
Les inhibiteurs des cotransporteurs sodium-glucose de type 2 (iSGLT2 ou gliflozines) améliorent le pronostic des patients avec insuffisance cardiaque, qu’ils présentent un diabète de type 2 ou non. Ils sont maintenant recommandés pour le traitement de l’insuffisance cardiaque dans les guidelines internationales. L’ajout d’une gliflozine pour cette indication cardiologique peut nécessiter d’ajuster le traitement antidiabétique. Le but de cette vignette est de discuter le risque éventuel de survenue d’une hypoglycémie, très délétère chez des patients fragiles à risque, suite à l’ajout d’un iSGLT2 chez des patients avec insuffisance cardiaque. Différentes…
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