Heart failure is one of the most common comorbidities of diabetes mellitus. Glucose-lowering therapies that can prevent heart failure or improve outcomes in patients with established heart failure are of critical importance among those with type 2 diabetes. Several types of glucose-lowering drugs have been assessed in this setting. Metformin has been shown to modestly improve the outcomes of patients with heart failure, whereas the effect of insulin in those with established heart failure is less clear. The effect of sulfonylureas on improving heart failure is controversial; observational reports have suggested that they are harmful in these patients, but these data have not been confirmed in randomized, controlled trials. Thiazolidinediones are contraindicated in patients with established heart failure and have also been known to cause heart failure. Furthermore, certain dipeptidyl peptidase 4 inhibitors seem to increase heart failure hospitalization. The effects of glucagon-like peptide 1 receptor agonists might differ in patients with or without established heart failure, particularly those with decompensated heart failure with a reduced ejection fraction. However, perhaps the most important finding has been that sodium/glucose cotransporter 2 (SGLT2; also known as SLC5A2) inhibitors reduce heart failure hospitalizations and, in the case of empagliflozin, markedly reduce the rate of cardiovascular death. Given the known neutral (or even harmful) effects of other glucose-lowering drugs on heart failure outcomes, SGLT2 inhibitors might well be considered the drug class of choice in patients with diabetes and heart failure, or in those at high risk of developing heart failure.

心力衰竭是糖尿病最常见的合并症之一。在患有2型糖尿病的患者中，可以预防心力衰竭或改善已确立的心力衰竭患者预后的降糖疗法至关重要。在这种情况下已经评估了几种类型的降糖药。已显示二甲双胍可适度改善心力衰竭患者的预后，而对已确定的心力衰竭患者的胰岛素作用尚不清楚。磺酰脲类药物改善心力衰竭的作用尚存争议。观察性报告表明它们对这些患者有害，但这些数据尚未在随机对照试验中得到证实。噻唑烷二酮类药物在已确定的心力衰竭患者中是禁忌的，并且也已知会引起心力衰竭。此外，某些二肽基肽酶4抑制剂似乎会增加心力衰竭的住院率。胰高血糖素样肽1受体激动剂的作用在有或没有已确立的心力衰竭的患者中可能有所不同，尤其是那些患有代偿性心力衰竭且射血分数降低的患者。但是，也许最重要的发现是钠/葡萄糖共转运蛋白2（SGLT2；也称为SLC5A2）抑制剂可减少心力衰竭的住院率，对于依帕列净而言，可显着降低心血管疾病的死亡率。鉴于其他降糖药物对心力衰竭结果具有已知的中性（甚至有害）作用，