Contemporary choice of glucose lowering agents in heart failure patients with type 2 diabetes.

Background: The choice of glucose lowering agent in heart failure (HF)-patients can have a strong effect on HF-related adverse events, with some classes increasing and other classes reducing the risk. Little data is available about the choice of glucose lowering agents in HF-patients with type-2-diabetes. Methods: We performed a cross-sectional single centre point analysis of all patients with both a diagnoses of HF and type-2-diabetes followed in a tertiary HF-clinic. Medical records were used to determine the choice of current glucose lowering agent. Data at the time of cross-sectional analysis was used to determine potential eligibility to a sodium-glucose-linked-transporter-2-inhibitor (SGLT2-inhibitor) based on the enrolment criteria of the EMPAREG-OUTCOME-trial. Results: A total of 571 HF-patients with diabetes were assessed on June the first 2017. The majority of patients were either managed with one or two glucose lowering agents (43% respectively 34%), with metformin ( N  = 391;61%), Insulin ( N  = 278;49%) and sulfonylurea ( N  = 259;45%) being the most frequently employed treatments. SGLT2-inhibitor use was low ( N  = 7;1%). According to trial criteria 184 patients (32%) qualified for an SGLT2-inhibitor. With main reasons for ineligibility being a HbA1C < 7% ( N  = 324) or a glomerular-filtration-rate <30 ml/min ( N  = 154; of whom 101 patients overlapped with HbA1C < 7%). However 54% of patients with a HbA1C < 7% were treated with ≥2 glucose lowering agents from a class other than SGLT-2-inhibiton. Conclusion: Despite potential eligibility, SGLT2-inhibition remains an underused glucose lowering agent in this contemporary HF-population. Additional research is necessary on optimising its implementation in clinical practice, which might include switching glucose lowering therapies in patients at HbA1C-target.