Which glucose-lowering therapies work best for heart failure and Type 2 Diabetes?
For people with type 2 diabetes and heart failure, choosing the right glucose-lowering medication is critical because some drugs can worsen heart failure while others protect the heart. The strongest evidence points to a class of drugs called SGLT-2 inhibitors (sodium-glucose cotransporter-2 inhibitors) as the best option. These medications not only lower blood sugar but also significantly reduce the risk of heart failure hospitalizations and cardiovascular death.
What the research says
Multiple large studies and meta-analyses consistently show that SGLT-2 inhibitors improve outcomes in people with type 2 diabetes and heart failure. A 2022 review in Heart Failure Clinics notes that SGLT-2 inhibitors were first developed as glucose-lowering drugs but were later found to consistently reduce heart failure hospitalizations and cardiovascular death in cardiovascular outcome trials 10. A network meta-analysis of 16 randomized trials involving 14,710 patients with heart failure with reduced ejection fraction (HFrEF) and type 2 diabetes found that the SGLT-2 inhibitor sotagliflozin showed the most substantial risk reduction for the composite of cardiovascular death or heart failure hospitalization (odds ratio 0.49) 2. Another meta-analysis of 10 studies in patients after acute coronary syndrome found that SGLT-2 inhibitors reduced the risk of first heart failure hospitalization by 22% and stroke by 44% 1. Research also suggests that SGLT-2 inhibitors may reduce arrhythmia recurrence after catheter ablation in patients with atrial fibrillation and heart failure 8. The mechanisms behind these benefits are still being studied, but one hypothesis is that SGLT-2 inhibitors reduce intracellular sodium in heart cells, improving mitochondrial function and energy supply 11. While other glucose-lowering therapies exist, the evidence for SGLT-2 inhibitors in heart failure is the most robust.
What to ask your doctor
- Is an SGLT-2 inhibitor (such as empagliflozin, dapagliflozin, or sotagliflozin) appropriate for my type 2 diabetes and heart failure?
- What are the potential side effects of SGLT-2 inhibitors, especially for my kidney function and risk of infections?
- How would adding an SGLT-2 inhibitor affect my current diabetes and heart failure medications?
- Should I have my heart function (ejection fraction) checked before starting a new diabetes medication?
- Are there any other glucose-lowering drugs, like GLP-1 receptor agonists, that might also benefit my heart?
This question is drawn from common patient questions about this topic and answered using cited medical research. We do not provide individualized advice.