Potential Role of SGLT2 Inhibitors in the Treatment and Prevention of Diabetic Cardiomyopathy

Diabetes cardiomyopathy (DCM) is a heart condition that leads to heart failure and is associated with increased mortality in diabetic individuals. It is distinguished by systolic and diastolic dysfunction, occurring independently of hypertension or coronary heart disease. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), a class of anti-diabetic drugs that enhance urinary salt and glucose excretion, have shown significant cardiovascular benefits. Large randomized clinical trials, such as EMPA-REG OUTCOME, CANVAS, and DECLARE-TIMI, highlight their efficacy in reducing cardiovascular mortality and heart failure hospitalizations in Type 2 diabetes mellitus (T2DM) patients, regardless of pre-existing cardiovascular disease (CVD). These benefits appear independent of blood glucose lowering and may involve direct cardioprotective effects. SGLT2i are thought to improve heart health through mechanisms affecting metabolism, mitochondrial function, oxidative stress, fibrosis, and autophagy. Given these benefits, SGLT2i are recommended for patients with T2D, heart failure with reduced ejection fraction, coronary heart disease, and albuminuric renal disease. Further research explores their role in diabetic cardiomyopathy prevention and treatment.