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The Biggest News in Diabetes, Heart Health, and Treatment Guidelines from the European Society of Cardiology

By Jimmy McDermott, Eliza Skoler, and Ursula Biba

SGLT-2 inhibitors and GLP-1 agonists recommended as first-line therapies; Farxiga offers heart health benefits in people with and without diabetes

The 2019 European Society of Cardiology Congress in Paris, France brought exciting news regarding diabetes and heart health. SGLT-2 inhibitors and GLP-1 agonists are now recommended as first-line medications for people who have diabetes and heart disease, and impressive study results show the heart protective benefits of SGLT-2 inhibitor Farxiga in people with and without type 2 diabetes.

The European Society of Cardiology released updated treatment guidelines for diabetes, prediabetes, and heart disease. These guidelines provide healthcare professionals with recommendations for diabetes care. In big news, SGLT-2 inhibitors and GLP-1 agonists are now recommended as first-line drugs in people with diabetes who have heart disease or a high risk for heart disease. First-line drugs are those that health care professionals prescribe first for a certain condition - in this case, for a heart condition called heart failure.

Why is this important? This is the first time a major guideline has recommended first-line usage of a drug other than metformin for type 2 diabetes. With strong data showing the heart and kidney health benefits of SGLT-2 inhibitors and GLP-1 agonists, starting with these drugs can protect the heart and kidneys and lower blood glucose.

The European Society of Cardiology Congress showcased the results of DAPA-HF – a trial that examined the heart health benefits of SGLT-2 inhibitor Farxiga (spelled Forxiga in Europe) in people with and without type 2 diabetes. An enthusiastic, standing-room only crowd applauded for the results:

  • Farxiga reduced heart-related death or worsening heart failure by 26% compared to placebo (a “nothing” pill).

  • The heart benefits were the same in people with diabetes and without diabetes.

Dr. John McMurray from University of Glasgow presented the results. He said that Farxiga “does everything we want a new heart failure drug to do: 1) reduce hospital admissions; 2) increase survival; and 3) improve symptoms – the three key objectives of treatment.” 

Farxiga is now the first SGLT-2 inhibitor to show use as a treatment for heart disease and to demonstrate beneficial effects in people without diabetes. In Europe, Farxiga is approved for people with both type 1 (for those with BMI greater than 27) and type 2 diabetes. In the US, Farxiga is currently only approved for type 2 diabetes – but given these results, hopefully it will be approved for heart failure in people with and without diabetes. This could bring a tremendous benefit to nearly six million people in the US who have heart failure, and millions more worldwide.

The majority (67%) of participants without diabetes in the trial did have prediabetes. This highlights the potential of these therapies to help people with heart disease and prediabetes – it would also improve blood glucose to prevent type 2 diabetes.

As a reminder, Farxiga is approved in Europe for type 1 diabetes. diaTribe would love to see more research on heart disease outcomes in people with type 1 diabetes. If you are interested in following progress on this front, please let us know!

For more information on heart health, check out our in-depth, two-part piece on heart failure from 2017 (Part 1 and Part 2).