The EMPRISE study specifically examined empagliflozin and its effects on hospitalization for HF.2 When compared with patients treated with sitagliptin, there was a statistically significant decrease in hospitalization for HF in patients with T2DM, both with and without preexisting cardiovascular disease.
This case highlights the relationship between T2DM and HF. We also show how the use of empagliflozin may have helped manage the patient’s undiagnosed HF and how its discontinuation luckily unmasked it. Routine evaluation for HF in patients with T2DM is not done, but likely there are patients who would benefit, especially given the strong, albeit less known, association between these 2 conditions.
Further studies are needed to determine the type of patients who would benefit most from HF screening. For now, the best practice is to obtain a complete medical history that includes current and recently discontinued medications as well a thorough physical examination for signs of fluid overload and cardiovascular compromise. Patients who may have signs concerning for HF can have appropriate testing and intervention.
Conclusions
SGLT2 inhibitors have been shown to have a role in the management of HF in patients with T2DM. There is a risk of exacerbation or unmasking of HF when discontinuing SGLT2 inhibitors. To our knowledge, this is the first paper describing the discovery of HF following interruption of SGLT2 inhibitor treatment. The clinician and patient should monitor for signs and symptoms of fluid overload when stopping therapy. Further research into the benefits of a more comprehensive evaluation is needed.