Diabetes and heart failure often go hand-in-hand. Recognizing this, recently developed diabetes medications called SGLT-2 inhibitors may be able to effectively treat heart failure in patients regardless of whether they have diabetes.

At Marshfield Clinic Health System, experts in pharmaceutical and heart failure work closely to determine the best treatment plan for heart disease patients. Jessica Geiger, heart failure nurse practitioner and Tonja Larson, clinical pharmacy specialist, explain.

“Diabetes is a known risk factor for developing heart failure and heart disease,” said Geiger. “Because of this, cardiovascular outcomes are typically monitored when new medications for diabetes are being studied.”

The use of sodium-glucose co-transporter 2 (SGLT-2) inhibitors may reduce the number of hospitalizations and mortality rate for heart failure patients. These medicines, however, are not to be used to treat type 1 diabetes.

What is an SGLT-2 inhibitor?

SGLT-2 inhibitors include medications such as empagliflozin (Jardiance®) and dapagliflozin (Farxiga®). These medicines lower blood sugar by passing sugar in the urine, according to Larson.

The SGLT-2 inhibitors also act as a diuretic to prevent excess fluid from building up in the body, which can also lead to the development of heart failure.

“What is not known, however, is the exact mechanism of how these medications decrease cardiovascular death,” Larson said.

Using SGLT-2 inhibitors to improve heart failure outcomes

SGLT-2 medications increase fluid loss and reduce stress on the heart as a result. More research is being done to determine if the inhibitors also help the heart pump more efficiently.

Research has shown that SGLT-2 inhibitors used to treat type 2 diabetes are beneficial in treating heart failure, Geiger said.

Monitoring SGLT-2 inhibitors use

Patients with type 2 diabetes who have an SGLT-2 inhibitor added to their medication regimen will need to have their blood pressure and blood glucose monitored to ensure doses of other medications would not need to be adjusted (e.g., diabetes, blood pressure, diuretic medications).

“SGLT-2 inhibitors are showing significant promise in the treatment of heart failure,” Geiger said.

There are potential side effects that need monitoring. “Patients who are started on these medications are monitored with lab work to ensure stable kidney function and are encouraged to monitor for any signs of genital rash, bladder or kidney infection symptoms,” she said.

Pros and cons of using SGLT-2 inhibitors

Like with most medications, using an SGLT-2 inhibitor has pros and cons, Larson said. In addition to helping reduce the risk of cardiovascular death and hospitalization for heart failure, the medications have shown to lower blood pressure, lower A1c and create weight loss. However, use of  SGLT-2 inhibitors may also increase risk for a variety of conditions such as bladder and kidney infections, low blood pressure, low blood sugar, diabetic ketoacidosis, increase in LDL (bad) cholesterol as well as increasing the risk for male and female genital mycotic (e.g. yeast) infections.

While diabetes alone can cause heart damage due to elevated blood sugar levels, patients with diabetes also are at an elevated risk for cardiovascular disease over time. Having more treatments available could help lower these risks.

“It is exciting to have another treatment option that can help optimize patients with heart failure,” Geiger said.

To learn more about SGLT-2 inhibitors, talk to your provider.