In dapagliflozin heart failure (DAPA-HF), dapagliflozin improved outcomes, irrespective of use, and no use of glucose-lowering medication (GLM) or by type of GLM used in patients with type 2 diabetes (T2D) and HF, and reduced ejection fraction (HFrEF).

Dapagliflozin is typically used as a second line GLM in T2D and often added to metformin, according to the study authors. In DAPA-HF, dapagliflozin improved clinical outcomes versus placebo in patients with HF and reduced HFrEF with or without T2D. These benefits were examined and varied by background GLM in the T2D cohort, including in drug naïve patients and in patients not on metformin.

The primary outcome was a composite of worsening HF, defined as hospitalization or an urgent visit requiring intravenous therapy or cardiovascular death. The effect of dapagliflozin versus placebo was examined using Cox proportional hazards models.

Out of 2139 T2D patients, 1596 were treated with GLM, 48% with metformin, 25% with insulin, 21% with sulfonylurea, 14% with DPP-4 inhibitor, and 1% with GLP-1 agonist. Drug naïve patients had a lower A1c and shorter T2D duration, whereas those who did not use metformin had a lower eGFR.

The effect of dapagliflozin on the primary outcome was consistent in the drug-naïve versus patients receiving GLM and across GLM classes, including those using versus not using metformin.


REFERENCE

Docherty K, Inzucchi SE, Kosiborod MN, et al. Does background T2D therapy modify the benefits of dapagliflozin in heart failure? Analysis of the DAPA-HF trial. American Diabetes Association: 80th Scientific Sessions: A Virtual Experience, June 12-16, 2020. https://plan.core-apps.com/tristar_ada20/abstract/bd27898a-60b9-459b-9a36-3694cdd40e7e.