Glucose-lowering therapy in patients with type 2 diabetes mellitus and heart failure
It is important to consider the cardiovascular safety and effectiveness in cardiovascular events when an antidiabetic therapy is started. Meformin is the first-line treatment for patients with DM2 and heart failure. Sodium–glucose cotransporter 2 inhibitors (SGLT2i) are safe in the presence of cardiovascular disease and reduce hospital admission for episodes of heart failure. Glucagon-like peptide receptor agonists (arGLP-1) emerge as an alternative to these patients, as they do not increase cardiovascular events or all-cause mortality.
Caution should be taken with dipeptidyl peptidase-4 inhibitors (DPP4i) in patients with heart failure, and saxagliptin is contraindicated. There is no conclusive evidence on cardiovascular safety in patients treated with sulfonylureas, glinides and acarbose. Insulin therapy can be considered a late alternative, due to the higher risk for complications in this subgroup of patients. Pioglitazone is contraindicated in patients with heart failure.