EUROPEAN ASSOCIATION FOR THE STUDY OF DIABETES OFFICIAL HIGHLIGHTS

EUROPEAN ASSOCIATION FOR THE STUDY OF DIABETES

Conference summaries


DIABETES & HF

DAPA-HF: dapagliflozin and prevention of adverse-outcomes in heart failure

Presented by: Mikhail Kosiborod, MD
Division of Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
Department of Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
The George Institute for Global Health, Sydney, Australia

Silvio Inzucchi, MD
Section of Endocrinology, Yale School of Medicine, New Haven, CT, USA
  • In patients with heart failure (HF) and reduced ejection fraction, the risk of worsening heart failure or death from cardiovascular causes was significantly lower with dapagliflozin than with placebo.
  • Of interest, the reduced risk was present regardless of the presence or absence of diabetes.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to reduce the risk of a first hospitalisation for HF. However, sufficient data is still lacking regarding the effects of SGLT2 inhibitors in patients with established HF and reduced ejection fraction, regardless of the presence or absence of type 2 diabetes.

  • DAPA-HF investigated the effects of dapagliflozin in patients with HF and reduced ejection fraction with or without diabetes.

Type of study, patients, and inclusion criteria

  • Randomised, phase 3, placebo-controlled trial.
  • New York Heart Association (NHYA) class II, III, or IV HF and an ejection fraction ≤40%.

Patient population

  • Total patients randomised: 4744.
  • Dapagliflozin 10 g/day (n = 2373).
  • Placebo (n = 2371).

Primary outcome measure

  • Composite of worsening HF (hospitalisation or an urgent visit resulting in intravenous therapy for HF) or cardiovascular death.
  • Over a median follow-up of 18.2 months, the primary outcome occurred in 16.3% of patients in the dapagliflozin group vs. 21.2% with placebo (HR, 0.74; 95% CI 0.65-0.85; P <0.001).
  • A first worsening HF event occurred in 10% of patients in the dapagliflozin group compared to 13.7% with placebo (HR, 0.70; 95% CI 0.59-0.83).
  • Death from cardiovascular causes occurred in 9.6% of patients treated with dapagliflozin compared to 11.5% in the placebo group (HR, 0.82; 95% CI 0.69-0.98).
  • Of note, findings in patients with diabetes were similar to those in patients without diabetes.
  • The frequency of adverse events related to volume depletion, renal dysfunction, and hypoglycaemia did not differ between treatment groups.
  • Among patients with HF and reduced ejection fraction, the risk of worsening HF or death from cardiovascular causes was lower among those who received dapagliflozin than placebo.
  • The reduced risk was present regardless of the presence or absence of diabetes.

Key Messages/Clinical Perspectives

  • These encouraging results substantially reinforce observations from previous clinical trials with dapagliflozin.
  • It remains to be seen if SGLT2 inhibitors should be used in eligible patients with HF and reduced ejection fraction, independently of the presence of comorbid diabetes.

 

Trial: NCT03036124



References

References


  1. McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med. September 19, 2019 - DOI: 10.1056/NEJMoa1911303

Presenter disclosure: The presenters has reported the follow relationships: M. Kosiborod: AstraZeneca, Boehringer Ingelheim, Amarin, Applied Therapeutics, Amgen, Bayer, Eisai, Glytec, GSK, Eli Lilly, Merck (Diabetes), Novartis, Novo Nordisk, Sanofi. S. Inzucchi: AstraZeneca, Boehringer Ingelheim, Novo Nordisk, Sanofi/Lexicon, Merck, VTV Therapeutics.

Medical writer: Patrick Moore, PhD

Reviewer: Marco Gallo, MD

Local reviewers: Marco Gallo, MD (Italia); Anna Novials Sardá, MD, PhD (España); Eric Renard, MD, PhD (France); Peter Schwarz, MD, PhD (Deutschland) 

Scientific Editor: Florian Toti, MD


CLINICAL TRIALS

T2D & NEPHROPATY

CREDENCE – Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy

Presented by: Carol Pollock, MBBS, PhD, FRACP, AAHMS; Hiddo Lambers Heerspink, PharmD, PhD; Kenneth W. Mahaffey, MD

PREVENTION

Results from the Anti-CD3 mAb (teplizumab) prevention trial

Presented by: Kevan Herold, MD; Peter S. Linsley, PhD

DIABETES & CVD

DECLARE study: call for action

Presented by: Itamar Raz, MD; Ofri Mosenzon, MD, MSc; Avivit Cahn, MD

T2D TREATMENT

VERIFY – Vildagliptin Efficacy in combination with metfoRmIn For earlY treatment of type 2 diabetes

Presented by: Chantal Mathieu, MD; Michael Stumvoli, MD; David R. Matthews, MD; Stefano del Prato, MD

DIABETES & HF

DAPA-HF: dapagliflozin and prevention of adverse-outcomes in heart failure

Presented by: Mikhail Kosiborod, MD; Silvio Inzucchi, MD

CV SAFETY

Results and implications of CAROLINA (CARdiOvascular Safety of LINAgliptin) comparing linagliptin vs glimepiride

Presented by: Julio Rosenstock, MD; Mark A. Espeland, MD; Steven E. Kahn, MD; Nikolaus Marx, MD; Bernard Zinman, MD; Darren McGuire, MD

T2D & CV PREVENTION

T1D DETERMINANTS

The Environmental Determinants of Diabetes in the Young (TEDDY) study

Presented by: Anette-Gabriele Ziegler, MD; Heikki Hyöty, MD, PhD
 

SYMPOSIA

NAFLD & DIABETES

EASD/EASL Symposium: is NAFLD a risk for health in the context of diabetes?

Presented by: Michael Roden, MD; Stefano Romeo, MD; Elisabetta Bugianesi, MD, PhD

HF & T2D

EASD/ESC Symposium: heart failure in type 2 diabetes

Presented by: M. Louis Handoko, MD; Javed Butler, MD, MPH, MBA

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