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Effect of glucose-lowering therapies on heart failure.

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eMediNexus Editorial    08 February 2018

A new article published in Nature Reviews discussed that heart failure is one of the most common comorbidities of diabetes mellitus and that glucose-lowering therapies that can prevent heart failure or improve outcomes in patients with confirmed heart failure are of critical importance among those with type-2 diabetes.

This article elaborated that various types of glucose-lowering drugs have been assessed in patients with diabetes mellitus having established heart failure. While metformin has shown to modestly improve outcomes of patients with heart failure, the effect of insulin in those with confirmed heart failure remains obscure. Additionally, the effect of sulfonylureas on improving heart failure is not yet confirmed. On the other hand, thiazolidinediones are contraindicated in patients with established heart failure and have also been known to cause heart failure. Whereas, the effects of glucagon-like peptide-1 receptor agonists differ in patients with or without established heart failure, especially in those with decompensated heart failure with a reduced ejection fraction. It was further stated that sodium/glucose cotransporter-2 (SGLT2) inhibitors, such as canaglifozin, have shown to reduce hospitalizations due to heart failure in patients with type-2 diabetes mellitus.

In summary, it was suggested that given the known neutral or harmful effects of other glucose-lowering drugs on heart failure outcomes, SGLT2 inhibitors should be considered the drug class of choice in patients with diabetes and heart failure and in those at high risk of developing heart failure.

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