Glucosuria during SGLT2 inhibitor therapy: Side effect or potential marker of success

Introduction. ISGLT2 is widely used to treat DM2, CHF and CKD. It works by blocking the reabsorption of glucose in the kidneys, leading to development of pharmacological glucosuria, natriuresis and mediating metabolic and cardioprotective effects.
Aim. To evaluate the frequency, severity and clinical significance of glycosuria in patients with CHF receiving iSGLT-2 inhibitors in real clinical practice.
Materials and methods. A stage study was conducted on 314 patients with CHF who were receiving iSGLT2 therapy.
Results. HFrEF was registered in 57.01% of patients, HFmrEF – in 14.33%, and HFpEF – 27.71%. Among them, 35.99% had T2DM and 60.83% had CHF with CKD. iSGLT-2 administration was accompanied by fasting glucosuria in 36.31% patients, among whom 21.97 had CKD and 19.43 had T2D. The prevalence of glucosuria depended on CHF phenotype: it was determined in 36.84% cases with HFpEF, 44.74 with HFrEF and 18.42 with HFPEF (p < 0.001). Glucosuria was observed significantly more often with the combination of CHF + DM2 (53.52 vs. 28.31%) p < 0.001. Frequency of drug-induced glycosuria in CHF patients did not depend on presence of CKD but was 35.08% with CKD vs 38.21 without CKD (P > 0.05). The severity of glucosuria in CHF and T2DM is directly correlated with HDN level, and in people with CHF without T2D it demonstrates a direct correlation with TG levels (r = 0.284, p < 0.002) and an inverse correlation with age (r = -0.127, p < 0.017).
Conclusions. Glucosuria associated with SGLT2 inhibitors developed in one-third of patients with CHF, significantly more often in those with concomitant T2DM and LVEF < 50%, regardless of the presence of CKD. Fasting glucosuria, induced by SGLT2 inhibitors in CHF is a marker of greater treatment effectiveness, identifying “responders” and can be considered a predictor of a more favorable prognosis.

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