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For T2DM with heart failure, semaglutide ranks highest for dual improvement in cardiac biomarkers and metabolic outcomes.
A systematic review and network meta-analysis has identified the most valuable diabetes medications for people living with type 2 diabetes mellitus (T2DM) and heart failure (HF)—a high-risk combination linked with increased cardiovascular events, hospitalizations, and mortality.
With newer antidiabetic therapies now advocated in major guidelines, this study fills a crucial knowledge gap by comparing their cardiac and metabolic outcomes directly. To determine which treatments deliver the strongest cardiometabolic protection, Huize Gao and other researchers reviewed 14 randomized controlled trials (RCTs) sourced from PubMed, EMBASE, and the Cochrane Library.
The Bayesian network meta-analysis compared sodium glucose cotransporter 2 (SGLT2) inhibitors—including canagliflozin, ipragliflozin, empagliflozin, remogliflozin, licogliflozin and dapagliflozin—with the GLP-1 receptor agonist semaglutide and the sulfonylurea glimepiride, focusing on outcomes like brain natriuretic peptide (BNP) levels, left ventricular ejection fraction (LVEF), glycated hemoglobin (HbA1c) reduction, and body-weight management, as well as overall safety.
Semaglutide leads in HF biomarker improvement
As per the findings, semaglutide provided the most favorable reduction in BNP, a key biomarker indicating improved HF status. This highlights semaglutide as an ideal option for those requiring aggressive cardiometabolic risk reduction, including both glucose control and heart function improvement.
Licogliflozin excels in weight loss for obesity-driven diabetes
Among all the evaluated drugs, licogliflozin yielded the strongest effect on body-weight reduction, a major therapeutic target in overweight and obese individuals battling T2DM and HF. Weight loss in such patients not only boosts metabolic health but also minimizes cardiac strain.
Dapagliflozin shows strong cardiac function benefits
Dapagliflozin portrayed the best improvement in LVEF, reinforcing its position as a leading cardioprotective SGLT2 inhibitor for people with HF—including those with reduced ejection fraction.
Glimepiride remains effective but requires caution
Although glimepiride markedly lowered HbA1c, the meta-analysis confirmed a higher likelihood of hypoglycemia, especially in elderly people or those with fluctuating glucose levels. Still, its cost-effectiveness and accessibility keep it relevant in many healthcare settings.
Drug safety: Licogliflozin and ipragliflozin rank best
Safety evaluations revealed that licogliflozin and ipragliflozin were related to the lowest rates of adverse events, supporting their use in those who require more cautious treatment selection. Meanwhile, dapagliflozin was linked to a greater likelihood of urinary tract infections, a known class effect of SGLT2 inhibitors.
Personalized therapy can optimize outcomes in diabetes-related HF
This study offers strong, evidence-based guidance for clinicians working to diminish HF progression and improve blood glucose control in T2DM patients. The findings suggest:
As the global prevalence of HF in diabetes continues to rise, treatment decisions must prioritize individualized, cardioprotective therapy choices to boost long-term survival and quality of life.
Frontiers in Endocrinology
Evaluation of three mechanisms of action (SGLT2 inhibitors, GLP-1 receptor agonists, and sulfonylureas) in treating type 2 diabetes with heart failure: a systematic review and network meta-analysis of RCTs
Huize Gao et al.
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