Impact of sodium-glucose cotransporter 2 inhibitors on blood glucose levels in patients with heart failure with reduced ejection fraction without diabetes

INTRODUCTION AND OBJECTIVES: Sodium-glucose cotransporter 2 inhibitors (SGLT2) were initially developed as antihyperglycemic agents for the management of type 2 diabetes mellitus (T2DM). This study sought to evaluate the impact of sodium-glucose cotransporter 2 inhibitors on blood glucose levels in patients with HFrEF without diabetes. METHODS: This randomized controlled trial included 130 patients with HF classified as NYHA class II to IV and without diabetes, with an ejection fraction (EF) below 40% as determined by echocardiography within the preceding three months. Baseline assessments included serum creatinine, random and fasting blood glucose, 2-hour postprandial glucose, HbA1c, urine acetone, BMI, blood pressure, and serum electrolytes (sodium, potassium, magnesium, ionized calcium, and phosphorus). After three months of treatment, all these clinical and laboratory parameters were reassessed in both groups. RESULTS: Treatment led to significant improvements in cardiac function, including reductions in left ventricular diameters and volumes, and increases in ejection fraction, tricuspid annular plane systolic excursion, and right ventricular fractional area change (p<0.05). Glycemic control also improved, with significant decreases in fasting, postprandial, HbA1c, and random blood glucose (p<0.001). Serum creatinine, magnesium, and phosphorus levels increased significantly (p<0.001). Adverse events were minimal, with only one patient showing urine acetone positivity (1.5%, p=0.99), and no symptomatic hypoglycemia, ketoacidosis, or significant hypotension occurred. CONCLUSIONS: SGLT2 inhibitors safely reduce blood glucose in patients with HFrEF without diabetes without causing hypoglycemia, highlighting their potential cardiovascular and metabolic benefits and supporting their use in this population.