Poor prognosis for T2D patients on loop diuretics in addition to SGLT2 inhibitor

Type 2 diabetes (T2D) patients with cardiovascular disease being treated with a sodium-glucose transport protein 2 (SGLT2) inhibitor have poorer outcomes if they also use loop diuretics. The poor prognosis also holds true for T2 diabetics who have not been diagnosed with heart failure (HF).

An analysis of the EMPA-REG OUTCOME trial (NCT01131676) compared T2D patients without HF who received loop diuretics in addition to the SGLT2 inhibitor empagliflozin (n=755) with T2D patients without HF and without loop diuretics (n=5,559), as well as T2D patients with HF taking both drugs (n=706) [1].

The results, presented by Prof. Pierpaolo Pellicori (University of Glasgow, United Kingdom), showed no significant interaction between loop diuretic use and HF for all endpoints studied. The baseline patient characteristics did differ significantly for some measures; patients using loop diuretics were older, had a higher body mass index, had worse renal function, were more likely to have had a myocardial infarction, and were more likely to have been diagnosed with diabetes 10 years earlier or longer. Regarding medicine use, the group on took significantly more beta-blockers, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers. Patients using loop diuretics in the absence of HF had intermediate outcomes between patients with and without HF, thus indicating that taking a loop diuretic is a marker for worse prognosis. Prof. Pellicori suggested that undiagnosed or unreported HF in this cohort may have been prevalent, because only 31% of patients taking a loop diuretic were diagnosed with HF.

1. Pellicori P, et al. Use of loop diuretics and outcomes in patients with type 2 diabetes: findings from the EMPA-REG OUTCOME trial. EASD 2020. Abstract #933.

Posted on 14 December 202022 February 2024