title: The Use of SGLT-2 Inhibitors in Type 2 Diabetes and Heart Failure.
abstract: The concurrent management of type 2 diabetes mellitus (T2DM) and chronic congestive heart failure presents several therapeutic challenges. Of concern is that insulin and insulin-sensitizing medications detrimentally "flood" the heart with energy-providing substrates, including fats and glucose. In this population, treatment of T2DM should focus on the reduction of increased substrate supply. Sodium glucose cotransporter-2 (SGLT-2) inhibitors, a new class of antidiabetic medication, operate via this principle by blocking the reabsorption of glucose in the kidney and subsequently releasing glucose through the urine. In this review, we begin with an examination of the mechanisms of glucotoxicity and lipotoxicity in the heart. Then we analyze the potential role of SGLT-2 inhibitor therapy in patients with concurrent T2DM and chronic heart failure. Based on the available evidence, SGLT-2 inhibitors are safe and can be recommended to treat T2DM in patients with chronic heart failure and intact renal function. Further studies are in progress to assess long-term survival benefits.
authors.affiliation: 1 Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Texas Health Science Center at Houston School of Medicine , Houston, Texas.
authors.forename: Kayla
authors.initials: K
authors.lastname: Riggs
authors.affiliation: 1 Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Texas Health Science Center at Houston School of Medicine , Houston, Texas.
authors.forename: Hiba
authors.initials: H
authors.lastname: Ali
authors.affiliation: 2 Division of Cardiology, Department of Medicine, University of Texas Health Science Center at Houston School of Medicine , Houston, Texas.
authors.forename: Heinrich
authors.initials: H
authors.lastname: Taegtmeyer
authors.affiliation: 1 Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Texas Health Science Center at Houston School of Medicine , Houston, Texas.
authors.forename: Absalon D
authors.initials: AD
authors.lastname: Gutierrez
mesh_terms: D000818:Animals; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000652:urine; D004734:Energy Metabolism / Q000187:drug effects*; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism / Q000652:urine; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism; D009206:Myocardium / Q000378:metabolism*; D065667:Renal Elimination / Q000187:drug effects; D051297:Sodium-Glucose Transporter 2 / Q000378:metabolism; D000077203:Sodium-Glucose Transporter 2 Inhibitors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; C089180:SLC5A2 protein, human; D051297:Sodium-Glucose Transporter 2; D000077203:Sodium-Glucose Transporter 2 Inhibitors