The sodium-glucose co-transporter 2 inhibitor (SGLT2i) dapagliflozin has consistent cardiovascular benefits across baseline kidney-function and albuminuria levels in high-risk patients with type-2 diabetes mellitus (T2DM)
Dapagliflozin consistently reduced the relative risk of cardiovascular events irrespective of baseline estimated glomerular filtration rate (eGFR) and albuminuria status in a broad population of patients with T2DM.
SGLT2is promote urinary glucose excretion and reduce the risk for cardiovascular death and hospitalizations for heart failure in patients with T2DM. However, The extent of increased glycosuria and, therefore, the glucose-lowering efficacy of SGLT2i is attenuated in patients with worse kidney function.
To examine what impact this might have the researchers conducted a prespecified analysis of the DECLARE-TIMI 58 trial, a cardiovascular-outcome trial that studied the effect of dapagliflozin versus placebo in more than 17,000 patients who had or were at risk for atherosclerotic cardiovascular disease.
Finally, They found that there is disconnect between cardiovascular efficacy and measures of glucose control and the SGLT2i should be considered in patients with T2DM and chronic kidney disease for the reduction of cardiovascular events.