ADA 2026: Subcutaneous Furosemide May Reduce Heart Failure Hospitalizations in Patients With Diabetes

Researchers presenting at the 2026 American Diabetes Association (ADA) Scientific Sessions in New Orleans, Louisiana, shared findings from a post-hoc analysis suggesting that subcutaneous (SC) furosemide injection (Furoscix; MannKind Corporation) may offer a meaningful advantage over usual oral diuretic therapy in reducing heart failure (HF) hospitalizations among persons living with diabetes mellitus (DM).¹

The Burden of HF: Why Furosemide Plays a Key Role

HF is one of the most serious and costly comorbidities associated with diabetes. The risk of developing HF is increased in individuals with obesity, diabetes mellitus, hypertension, and chronic kidney disease, and research has demonstrated that DM is associated with a higher rate and burden of hospitalization in people with HF, including elevated rates of decompensated HF events. Recognizing the scale of this risk, the ADA's 2025 Standards of Care recommend that clinicians consider screening asymptomatic adults with diabetes for heart failure using natriuretic peptide levels.^1-3

Against this backdrop, the AT HOME-HF trial evaluated the potential of SC furosemide as an outpatient alternative to intravenous (IV) diuresis. Furoscix is an 80 mg/10 mL buffered formulation of furosemide designed for self-administered SC delivery. Subcutaneous infusion using a biphasic delivery profile resulted in complete bioavailability (99.65%) and equivalent diuresis when compared with 80 mg of IV furosemide, with therapeutic levels reached within 30 minutes and maintained for up to 6 hours.^4,5

The AT HOME-HF study was an open-label, randomized pilot trial in which patients with HF and signs and symptoms of fluid overload were randomized 2:1 to receive SC furosemide (once or twice daily) or usual care (UC), defined as oral diuretic augmentation guided by investigator clinical judgment. The post-hoc analysis presented at the ADA sessions stratified 30-day hospitalization outcomes by DM status.^1,6

Of 51 patients with HF enrolled, 28 (57%) had concomitant DM—19 (56%) in the SC furosemide group and 9 (53%) in the UC group. Among persons with diabetes, HF hospitalization occurred in 11% of those receiving SC furosemide compared with 22% of those receiving UC. Additionally, among patients with DM who were hospitalized, the mean time to admission was 17 days for SC furosemide versus just 4 days for UC, a clinically meaningful difference suggesting that SC furosemide may delay disease deterioration requiring inpatient care. Ninety percent of SC furosemide doses were administered within the first 7 days, with 97% delivered once daily.¹

Pharmacy Implications: Ambulatory, Primary, and Cardiology Care Settings

These findings build on prior evidence supporting the outpatient use of furosemide. An earlier trial (FREEDOM-HF) comparing outpatient furosemide to hospital admission for IV diuresis found that no patients in the furosemide group required an initial HF hospital admission, and 96% of furosemide-treated patients remained out of the hospital for 30 days after treatment. Admitting patients to the hospital solely for the administration of IV furosemide is expensive and increases risks of hospital-associated morbidity and mortality, underscoring the need for treatment paradigms that shift HF management outside of the hospital.^7-8

The poster's authors noted that the results were descriptive only and that larger studies are warranted to validate the findings in the DM population. Nevertheless, they emphasized the clinical relevance for pharmacists and other clinicians who manage patients with diabetes, who face elevated HF risk and may benefit from awareness of SC furosemide as a strategy to reduce hospitalizations.¹

Pharmacists practicing in ambulatory care, primary care, and cardiology settings are well positioned to identify patients with diabetes who may be candidates for outpatient diuretic augmentation with SC furosemide. As the intersection of diabetes and HF continues to drive substantial health care utilization, tools that enable hospital avoidance—without sacrificing diuretic efficacy—represent an important addition to the outpatient management toolkit.¹

REFERENCES

1. Ahuja A, Kamineni P, Luepke K, et al. Subcutaneous (SC) furosemide (FUR) use for fluid overload in persons living with diabetes mellitus. Presented at: 2026 American Diabetes Association Scientific Sessions; June 5-8, 2026; New Orleans, Louisiana. Accessed Via ADA Scientific Sessions Online Platform.

2. American Diabetes Association Professional Practice Committee. 10. Cardiovascular disease and risk management: Standards of Care in Diabetes—2025. Diabetes Care. 2025;48(Suppl 1):S207–S238. doi:10.2337/dc25-S010

3. Malik A, Garland E, Drozd M, et al. Diabetes mellitus and the causes of hospitalisation in people with heart failure. Diab Vasc Dis Res. 2022;19(1):14791641211073943. doi:10.1177/14791641211073943

4. Kambhampati SRS, Lam PH, Deedwania P, et al. Subcutaneous furosemide in heart failure: pharmacokinetic characteristics of a newly buffered solution. JACC Basic Transl Sci. 2018;3(1):25-34. doi:10.1016/j.jacbts.2017.10.001

5. Avoiding treatment in the hospital with Furoscix for the management of congestion in heart failure – A pilot study (AT HOME-HF). ClinicalTrials.gov Identifier: NCT04593823. Last Updated August 1, 2023. Accessed June 8, 2026. https://clinicaltrials.gov/study/NCT04593823

6. Bhatt AS, Cooper LB, Ezekowitz J, et al. Avoiding treatment in hospital with subcutaneous furosemide for worsening heart failure: a pilot study (AT HOME-HF). JACC Heart Fail. 2024;12(11):1830-1841. doi:10.1016/j.jchf.2024.07.015

7. van Deursen VM, Urso R, Laroche C, et al. Co-morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey. Eur J Heart Fail. 2014;16(1):103–111.doi:10.1002/ejhf.30

8. Furoscix real-world evaluation for decreasing hospital admissions in heart failure (FREEDOM-HF). ClinicalTrials.gov Identifier: NCT03458325. Last Updated February 24, 2023. Accessed June 8, 2026. https://clinicaltrials.gov/study/NCT03458325