Sodium–Glucose Cotransporter 2 Inhibitors in Patients with Diabetes and Coronary Artery Disease: Translating the Benefits of the Molecular Mechanisms of Gliflozins into Clinical Practice

Abstract

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) were initially developed for the treatment of diabetes due to their antihyperglycemic activity. However, in the light of the most recent clinical studies, they are revolutionizing the approach to cardiovascular disease in patients with and without diabetes. We aimed to generate real-world data about the use of SGLT2i in patients with T2DM and coronary artery disease (CAD), focusing on their effectiveness in glycemic control, adherence, long-term efficacy, and safety outcomes. On the basis of the inclusion and exclusion criteria, 143 patients were enrolled. Patients were treated with canagliflozin (n = 33 patients; 23%), dapagliflozin (n = 52 patients, 36.4%), empagliflozin (n = 48 patients; 33.6%), or ertugliflozin (n = 10 patients; 7%) as monotherapy or in combination with other antidiabetic drugs. All patients performed a clinical visit, and their medical history, blood sampling, and anthropometric parameters were measured at discharge and at 1-year follow-up. The reduction in HbA1c % value at 12 months was significant (8.2 vs. 7.4; p < 0.001). Trends in body weight and body mass index also confirmed the positive effect of the treatment (p < 0.0001), as did the reduction in abdominal adiposity (expressed via waist circumference). At 1-year follow-up, 74.1% of patients were adherent to the treatment, and 81.1% were persistent to the treatment. A total of 27 patients (18.8%) had to discontinue treatment early due to drug intolerance caused by genitourinary infections (11.9%), the drub being permanently ineffective (HbA1c not at target or decreasing: 4.9%), or because of expressing. a desire not to continue (2%). No major drug-related adverse events (diabetic ketoacidosis, Fournier’s gangrene, lower-limb amputations) occurred at follow-up, while MACE events occurred in 14 patients (9.8%). In real-world patients with T2DM and CAD, SGLT2i have been effective in long-term glycemic control and the improvement in anthropometric indices with good tolerance, high adherence, persistence to treatment, and no major adverse events at 1-year follow-up.

Use of sodium‐glucose cotransporter‐2 inhibitors in France: Analysis of French nationwide health insurance database

“…Nargesi et al evaluated the persistence of GLP‐1RA and SGLT‐2i use in the United States 29 and found similar results to ours, with persistence of SGLT‐2i treatment at 1 year in 52.9% of new users. In the study by Cesaro et al, 30 81.1% of patients with coronary artery disease and type 2 diabetes mellitus were still taking SGLT‐2i after 1 year. Lee and Lee 31 found a proportion of persistent patients after 1 year varying between 44.3% and 72.1% according to the study.…”

Sodium Glucose Co-Transporter 2 Inhibitors and the Cardiovascular System: Current Knowledge and Future Expectations

“…Data from real-world patients suggested that in the long-term, patients with diabetes and CAD, treated with SGLT2i, had low glucose levels, a high adherence and persistence to treatment and a low number of MACE. 77 The first trial that assessed the use of empagliflozin after percutaneous coronary intervention following AMI was the Impact of empagliflozin on cardiac function and biomarkers of heart failure in patients with acute myocardial infarction (EMMY; ClinicalTrials. gov identifier: NCT03087773) trial.…”