[Diabetic cardiomyopathy: a focus on sodium-glucose cotransporter type 2 inhibitors].

Abstract

Diabetic cardiomyopathy (DCM) is a complication of type 2 diabetes mellitus (T2DM) capable of progressing to the development of symptomatic heart failure (HF), independently of traditional risk factors for it, such as coronary artery disease and hypertension. There is no specific treatment for DCM; however, sodium-glucose cotransporter 2 inhibitors (SGLT2i) are hypoglycemic drugs that act on SGLT2 channels, inhibiting glucose reabsorption in the kidney. In addition, they have cardioprotective effects, which is why their mechanisms at the cardiac level have been studied. According to the results of preclinical studies, SGLT2i act by interfering in the pathophysiology of DCM. Their main effects are: improvement in diastolic function and left ventricular ejection fraction (LVEF), attenuation in the progress of cardiac fibrosis, reduction of oxidative stress and proinflammatory markers. The clinical trials in humans specifically with DCM that have been carried out are limited; however, randomized clinical trials in patients with HF have shown benefits with SGLT2i, regardless of glycemic control in the reduction of hospitalization for HF and mortality from cardiovascular causes. In summary, SGLT2i suggest a treatment in DCM due to their cardiovascular benefits, in preclinical and clinical models of DCM and in the glycemic control of T2DM.