Diabetes and heart failure. Are type two sodium-glucose cotransporter inhibitors the future of treatment?
DOI:
https://doi.org/10.19230/jonnpr.4443Keywords:
Diabetes Mellitus; New treatments; Heart failure; sodium-glucose cotransporter type 2 inhibitorsAbstract
Introduction. Diabetes mellitus is a metabolic disease whose incidence and prevalence are increase. It produces multiple complications such as atherosclerotic disease and cardiac insufficiency, heart disease, the latter being one of the main causes of death. Diabetes mellitus can lead to heart failure through diabetic cardiomyopathy.
For its treatment, sodium-glucose cotransporter type 2 inhibitors stand out. (iSGLT2), drugs that act on the renal proximal convoluted tubule.
Objective. to know the impact of iSGLT2 in the treatment of diabetes mellitus with nsufficiency associated heart failure, identify the mechanisms that relate diabetes mellitus and heart failure and know the management of this type of patients.
Results and Discussion. Cardiovascular safety studies EMPAREG-OUTCOME, CANVAS DECLARE-TIMI 58 and CREDENCE have shown that empagliflozin, canagliflozin, and dapagliflozin they reduce the risk of major cardiovascular events, death due to cardiovascular causes and reduce the percentage of hospitalizations for heart failure. Its mechanism of action is not entirely clear, however, its glycosuric and natriuretic effects are potentially beneficial on the blood pressure, body weight, cardiac remodeling and renal function.
These studies also point out the importance of knowing side effects and monitoring them to prevent them, which, although rare, can cause infections or amputations.
Conclusions. according to current evidence, iSGLT2 constitute the best therapeutic option in patients with diabetes and concomitant heart failure and those with chronic kidney disease (GFR between 30-60 ml/min/1.73 m2), also recommending its use in those patients with heart failure without diabetes
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