HelixTalk Episode #103 - How Can Peeing Sugar Improve Heart Failure? No One Knows, but We Know It Works!

Date posted: October 22, 2019, 6:00 am

In this episode, we discuss the newly published DAPA-HF trial, which studied dapagliflozin (a drug for diabetes) among patients who had heart failure with reduced ejection fraction (HFrEF) many of which did NOT have a history of diabetes.

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Key Concepts

1. Dapagliflozin (Farxiga) is an SGLT2 inhibitor approved for type II diabetes mellitus.  The drug works by increasing urinary loss of glucose when blood glucose exceeds about 70-90 mg/dL.
2. Dapagliflozin was recently studied in patients with heart failure with reduced ejection fraction (HFrEF), also known as systolic heart failure.  The study included patients with and without diabetes.  This study, called the DAPA-HF trial, demonstrated a mortality and heart failure hospitalization benefit with dapagliflozin over placebo both in patients with and without diabetes. 
3. The DAPA-HF trial may not have properly represented adverse effects that are known to occur with SGLT2 inhibitors.  At this time, the true incidence rate of certain adverse effects among non-diabetics is not well known.
4. Heart failure guidelines are very likely to evaluate DAPA-HF and other ongoing clinical trials.  It is likely that SGLT2 inhibitors will be recommended as part of the multitude of different medications used in patients with HFrEF.

References

• DAPA-HF Trial: McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019 Sep 19. doi: 10.1056/NEJMoa1911303.