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Relationship Between HbA1c Level and Effectiveness of SGLT2 Inhibitors in Decompensated Heart Failure Patients with Type 2 Diabetes Mellitus
International Heart Journal ( IF 1.5 ) Pub Date : 2021-07-30 , DOI: 10.1536/ihj.20-764
Masaki Nakagaito 1 , Teruhiko Imamura 2 , Shuji Joho 2 , Ryuichi Ushijima 2 , Makiko Nakamura 2 , Koichiro Kinugawa 2
Affiliation  

The DAPA-HF trial demonstrated that sodium-glucose cotransporter 2 inhibitors (SGLT2i) reduced worsening heart failure (HF) events in chronic HF patients with or without type 2 diabetic mellitus (T2DM). However, it remains unclear whether the effectiveness of SGLT2i is also observed in patients with decompensated HF irrespective of HbA1c level. Eighty-one T2DM patients hospitalized due to decompensated HF were enrolled and divided into 2 groups according to their HbA1c levels (group H, HbA1c 6.9-13.0%, n = 41; group L, HbA1c < 6.9%, n = 40). After the initial management of HF, one of the SGLT2i (canagliflozin 100 mg/day or dapagliflozin 5 mg/day or empagliflozin 10 mg/day) was non-randomly administered, and clinical parameters associating with HF and T2DM were followed for 7 days. No symptomatic hypoglycemia was observed in any patient. In both groups, urine glucose excretion was increased significantly after the administration of SGLT2i. However, its amount was greater in group H than group L. Urine volume was increased significantly at day 1 in both groups. Urine volume returned to the baseline after one week in group L. In contrast, the increase in urine volume persisted at least for one week in group H. Of note, a decrease in B-type natriuretic peptide levels after the initiation of SGLT2i was observed in both groups similarly despite differences in urine output and excretion of urine glucose. In conclusion, SGLT2i can improve decompensated HF in patients with T2DM irrespective of the HbA1c level.



中文翻译:

HbA1c 水平与 SGLT2 抑制剂对 2 型糖尿病失代偿性心力衰竭患者有效性的关系

DAPA-HF 试验表明,钠-葡萄糖协同转运蛋白 2 抑制剂 (SGLT2i) 减少了患有或不患有 2 型糖尿病 (T2DM) 的慢性 HF 患者的心力衰竭 (HF) 恶化事件。然而,目前尚不清楚是否在失代偿性 HF 患者中也观察到 SGLT2i 的有效性,而不管 HbA1c 水平如何。将 81 名因失代偿性 HF 住院的 T2DM 患者根据 HbA1c 水平分为 2 组(H 组,HbA1c 6.9-13.0%,n = 41;L 组,HbA1c < 6.9%,n= 40)。在对 HF 进行初始治疗后,非随机施用其中一种 SGLT2i(卡格列净 100 毫克/天或达格列净 5 毫克/天或恩格列净 10 毫克/天),并跟踪与 HF 和 T2DM 相关的临床参数 7 天。在任何患者中均未观察到有症状的低血糖。在两组中,SGLT2i 给药后尿糖排泄量均显着增加。然而,H 组的尿量大于 L 组。两组的第 1 天尿量均显着增加。L组一周后尿量恢复到基线水平。相比之下,H组尿量增加至少持续一周。 值得注意的是,尽管尿量和尿糖排泄存在差异,但在开始 SGLT2i 后,两组均观察到类似的 B 型利钠肽水平下降。总之,无论 HbA1c 水平如何,SGLT2i 都可以改善 T2DM 患者的失代偿性 HF。

更新日期:2021-07-30
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