Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jul 15, 2024; 15(7): 1518-1530
Published online Jul 15, 2024. doi: 10.4239/wjd.v15.i7.1518
Dapagliflozin in heart failure and type 2 diabetes: Efficacy, cardiac and renal effects, safety
Pei-Ling Yu, You Yu, Shuang Li, Bai-Chen Mu, Ming-Hua Nan, Min Pang
Pei-Ling Yu, You Yu, Shuang Li, Bai-Chen Mu, Ming-Hua Nan, The Second Department of Cardiology, The Second Affiliated Hospital of Liaoning Hospital of Traditional Chinese Medicine, Shenyang 110034, Liaoning Province, China
Min Pang, Department of Outpatient, The Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 110034, Liaoning Province, China
Co-corresponding authors: Ming-Hua Nan and Min Pang.
Author contributions: Yu PL designed the study; Yu PL, Yu Y, Li S and Mu BC collected the data and performed the study; Yu PL, Nan MH and Pang M analysed the data and wrote the manuscript. All authors have read and approved the final manuscript. The reasons for designating Nan MH and Pang M as co-corresponding authors are twofold. First, the research was performed as a collaborative effort, and the designation of co-corresponding authors authorship accurately reflects the distribution of responsibilities and burdens associated with the time and effort required to complete the study and the resultant paper. This also ensures effective communication and management of post-submission matters, ultimately enhancing the paper's quality and reliability. Second, the overall research team encompassed authors with a variety of expertise and skills from different fields, and the designation of co-corresponding authors best reflects this diversity. This also promotes the most comprehensive and in-depth examination of the research topic, ultimately enriching readers' understanding by offering various expert perspectives.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the Second Affiliated Hospital of Liaoning Provincial Hospital of Traditional Chinese Medicine, No. 20180215.
Informed consent statement: The present study was retrospective and permission to waive informed consent was obtained.
Conflict-of-interest statement: This study does not contain any conflict of interest.
Data sharing statement: All data can be obtained from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ming-Hua Nan, MD, Chief Physician, The Second Department of Cardiology, The Second Affiliated Hospital of Liaoning Hospital of Traditional Chinese Medicine, No. 60 Huanghe North Street, Huanggu District, Shenyang 110034, Liaoning Province, China. 18860933@qq.com
Received: February 20, 2024
Revised: April 12, 2024
Accepted: May 14, 2024
Published online: July 15, 2024
Processing time: 139 Days and 1.3 Hours
Abstract
BACKGROUND

Heart failure (HF), especially HF with reduced ejection fraction (HFrEF), presents complex challenges, particularly in the aging population where it often coexists with type 2 diabetes mellitus (T2DM).

AIM

To analyze the effect of dapagliflozin treatment on cardiac, renal function, and safety in patients with HFrEF combined with T2DM.

METHODS

Patients with T2DM complicated with HFrEF who underwent treatment in our hospital from February 2018 to March 2023 were retrospectively analyzed as the subjects of this study. The propensity score matching method was used, and a total of 102 eligible samples were scaled. The clinical efficacy of the two groups was evaluated at the end of the treatment, comparing the results of blood glucose, insulin, cardiac function, markers of myocardial injury, renal function indexes, and 6-min walk test (6MWT) before and after the treatment. We compared the occurrence of adverse effects on the treatment process of the two groups of patients. The incidence of adverse outcomes in patients within six months of treatment was counted.

RESULTS

The overall clinical efficacy rate of patients in the study group was significantly higher than that of patients in the control group (P = 0.013). After treatment, the pancreatic beta-cell function index, left ventricular ejection fraction, and glomerular filtration rate of patients in the study group were significantly higher than control group (P < 0.001), while their fasting plasma glucose, 2-h postprandial glucose, glycosylated hemoglobin, insulin resistance index, left ventricular end-systolic diameter, left ventricular end-diastolic diameter, cardiac troponin I, creatine kinase-MB, N-terminal pro b-type natriuretic peptide, serum creatinine, and blood urea nitrogen were significantly lower than those of the control group. After treatment, patients in the study group had a significantly higher 6MWT than those in the control group (P < 0.001). Hypoglycemic reaction (P = 0.647), urinary tract infection (P = 0.558), gastrointestinal adverse effect (P = 0.307), respiratory disturbance (P = 0.558), and angioedema (P = 0.647) were not statistically different. There was no significant difference between the incidence of adverse outcomes between the two groups (P = 0.250).

CONCLUSION

Dapagliflozin significantly enhances clinical efficacy, cardiac and renal function, and ambulatory capacity in patients with HFrEF and T2DM without an increased risk of adverse effects or outcomes.

Keywords: Heart failure, Type 2 diabetes mellitus, Heart failure with preserved ejection fraction, Myocardial infarction markers, Cardiac function

Core Tip: This study delves into the complex association between type 2 diabetes mellitus (T2DM) and heart failure (HF) with preserved ejection fraction, focusing on how the two disorders interact through multiple mechanisms, leading to alterations in cardiac structure and function. Special attention is paid to the role of T2DM in promoting myocardial interstitial fibrosis and decreased cardiac function, and how these alterations exacerbate the course of HF, thus providing new perspectives on the treatment of these patients.