COMPARISON OF SGLT2 INHIBITORS AND DPP4 INHIBITORS IN DIABETIC PATIENTS WITH HEART FAILURE

Abstract

Introduction: Type 2 diabetes mellitus (T2DM) markedly elevates the risk of cardiovascular problems, including heart failure (HF). Although sodium-glucose co-transporter-2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitors (DPP4i) are frequently utilized for glycemic management, their relative effects on clinical outcomes in diabetic patients with heart failure have not been well assessed in local contexts.  

Objectives: To compare the outcome of DPP4 inhibitor and SGLT2 inhibitor among diabetic patients presenting with heart failure in a tertiary care hospital.

Subjects & Methods: This randomized clinical trial was performed in the Department of Cardiology, Fauji Foundation Hospital in Rawalpindi. 452 individuals aged 40 to 80 years with T2DM and clinically proven heart failure were randomized into two equal groups: Group A received dapagliflozin 10 mg daily (SGLT2 inhibitor), and Group B received vildagliptin 50 mg twice day (DPP-4 inhibitor). Patients were monitored biweekly. The primary outcomes included hospitalization due to heart failure and cardiovascular or cerebrovascular consequences. Data were evaluated utilizing SPSS Version 25, employing a Chi-square test for comparison; p < 0.05 was deemed significant.

Results. Hospitalization due to heart failure was observed in 29.6% of individuals in the SGLT2i group compared to 50.0% in the DPP4i sample (p < 0.001). Hospitalization due to cardiovascular or cerebrovascular events was reduced in the SGLT2i group (6.2% compared to 14.2%). Hospitalization was not found in 64.2% of SGLT2i users, in contrast to 35.8% of DPP4i users. The advantages of SGLT2i treatment were consistent among subgroups categorized by gender, age, BMI, ejection fraction, and disease duration.

Conclusions: SGLT2 inhibitors markedly reduce hospitalization rates for heart failure and cardiovascular/cerebrovascular incidents in diabetic patients with heart failure when compared to DPP4 inhibitors. These findings endorse the preferential utilization of SGLT2 inhibitors for cardiovascular protection in this high-risk demographic.