Abstract
OBJECTIVE: This study aims to evaluate the effects of SGLT2 inhibitors, specifically empagliflozin and dapagliflozin, on the prevention of heart failure hospitalizations and the improvement of metabolic control in patients with type 2 diabetes mellitus (T2DM) without documented high cardiovascular risk. The study aimed to assess the impact of these treatments on glycemic control, blood pressure, weight, and cardiovascular outcomes over an 18-month follow-up period in a Colombian population. MATERIALS AND METHODS: A retrospective cohort study was conducted with 122 patients with uncontrolled T2DM at the Clínica Imbanaco in Cali, Colombia. Five treatment groups were identified, including various metformin combinations with other agents intensified with empagliflozin and dapagliflozin. Patients were retrospectively followed for 18 months, assessing treatment effects on the first hospitalization due to heart failure, glycemic control, blood pressure, and body weight. Multivariate repeated-measures ANOVA was used to analyze clinical variable changes over time. Additionally, Kaplan-Meier survival analysis estimated the cumulative probability of hospitalization for each treatment group, and Cox regression evaluated associations between different treatments and the risk of heart failure hospitalization. RESULTS: Patients treated with metformin + empagliflozin showed a significant reduction in HbA1c levels, from an initial mean of 7.75% to 6.77% at the end of follow-up (-0.97%; 95% CI: -1.31 to -0.63, p < 0.001) compared to baseline. Blood pressure in the empagliflozin group also showed significant decreases. Final systolic blood pressure reached an average of 120.40 mmHg (95% CI: -22.63 to 1.54, p > 0.05), reflecting a -10.55 mmHg reduction from baseline. Diastolic blood pressure decreased to an average of 78 mmHg (95% CI: -10.71 to -0.69, p < 0.05), with a reduction of -5.7 mmHg compared to baseline. Regarding hospitalizations, Cox regression analysis indicated an HR of 0 for the empagliflozin group (p < 0.001), with no reported heart failure hospitalizations during the study period. CONCLUSIONS: Analysis of left ventricular ejection fraction and first heart failure hospitalization in patients with T2DM treated with SGLT2 inhibitors reveals that empagliflozin is not only effective in glycemic control, weight management, and blood pressure reduction but also shows preventive potential against heart failure progression, even in patients without high cardiovascular risk. These findings, aligned with evidence from classical studies, suggest that empagliflozin should be considered in the early management of T2DM to reduce heart failure incidence and improve long-term outcomes.