SGLT2 Inhibitors Shown to Reduce Risk of Heart Attacks and Strokes in People with Type 2 Diabetes

With Amy Hess-Fischl RD

The diabetes medication cut in half the risk of heart failure and other cardiac events in a comprehensive new study

Red blood cells

It's no secret that people with type 2 diabetes are at an increased risk for major health complications. But one class of medicine might be able to change that, researchers say. According to a recent study published in the British Medical Journal (BMJ), a type of medication called SGLT2 inhibitors reduced the risk of heart failure and stroke among patients with type 2 diabetes, suggesting they have cardio-protective benefits.

What are SGLT2 inhibitors?

Otherwise known as sodium glucose co-transporter 2 inhibitors, SGLT2 inhibitors are a class of medication, delivered in pill form, that can help lower blood glucose levels in diabetic patients.

“SGLT2 inhibitors are a relatively new class of medication that can have really impressive results,” says Amy Hess-Fischl RD, a certified diabetes educator at the University of Chicago. While most diabetes medications either increase insulin or insulin sensitivity, SGLT2 inhibitors cause the kidneys to excrete glucose into the urine, preventing it from being reabsorbed back into the bloodstream.

By decreasing blood sugar levels, SGLT2 inhibitors can help improve your A1C levels as well, and potentially even aid in medically advised weight loss. According to recent research from Johns Hopkins University, SGLT2 inhibitors typically improve A1C levels anywhere from 0.5% to 1% when taken daily over the course of six months.

Because SGLT2s help decrease sugar in the blood, this also helps reduce some of the complications and long-term damage that can come from having high blood sugar. 

“Glucose is very attracted to hemoglobin, which is in our red blood cells,” says Fischl. “The more sugar we have in our blood, the more it can attach to the hemoglobin, and the harder our red blood cells get. Those hard red blood cells, pounding up against our blood vessels for years on end, can cause a lot of damage.”

One recent study published in the 2019 issue of the New England Medical Journal (NEJM) found that the risk of renal failure was 30 percent lower in patients with type 2 diabetes who took the SGLT2 inhibitor Canagliflozin, compared with patients in the control group who took a placebo.

Why the newest research about SGLT2 inhibitors is so promising

The latest research, published in the September 2020 issue of the British Medical Journal (BMJ), reinforces what earlier studies have shown: SGLT2s can protect against heart attack, heart failure, and stroke among patients with type 2 diabetes.

The study authors used five years of healthcare data from type 2 diabetes patients across Canada and the United Kingdom. They surveilled over 200,000 patients who took SGLT2 inhibitors and compared them to the same number of patients who took another class of medication known as DPP-4 inhibitors. (DPP-4s help reduce blood sugar levels in diabetic patients by increasing insulin.) The researchers then recorded any major cardiac events such as heart attack, stroke, and heart failure for an average of 11 months.

The results showed that SGLT2 inhibitors were associated with a lower risk of cardiac events in type 2 diabetics when compared to DPP-4 inhibitors. For example, the rate of heart failure was 3.1 events per 1,000 people among patients who took SGLT2s and 7.7 events per 1,000 people among patients who took DPP-4s. Heart attacks, strokes, and overall mortality rates were also lower in patients who took SGLT2s. These results were consistent across age, sex, past insulin use, and history of cardiovascular disease, the study found.

Possible limitations and side effects of SGLT2 inhibitors

While the new study produced notable results, it also has some limitations. “Observational studies are just that – observational,” according to Hess-Fischl. “They're nice because they give researchers a place to start, but we really need comparative data next.”

Additionally, while it may be true that SGLT2s have some cardioprotective benefit, people with type 2 diabetes should be aware that the medication is not without risk.

“What we've been finding is that SGLT2s tend to increase the risk of a condition called Euglycemic Diabetic Ketoacidosis, which is a life-threatening condition caused by a buildup of ketones in the bloodstream," Hess-Fischl says. SGLT2s can also cause urinary tract infections – particularly in females – due to increased sugar being excreted in urine. They are also contraindicated for patients in kidney failure.

All in all, Fischl says, while SGLT2s can be “a godsend” for some patients with type 2 diabetes, they're far from a miracle drug. More research, such as double-blind placebo studies, is still needed to determine whether or not they can truly guard against cardiac events.

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