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First experience with sodium-glucose co-transporter 2 inhibitors in Polish patients with cardiovascular diseases.

Type 2 diabetes mellitus (DM2) is a serious public health burden, and is one of the prime causes of morbidity and mortality in patients with cardiovascular diseases (CVD), like coronary artery disease (CAD), heart failure (HF), stroke or peripheral artery disease [1–4]. However, until recently, DM2 management with tight glycemic control, has not been associated with any major improvement in terms of survival in patients with CVD. Thus, the recent introduction of a novel class of agents for the treatment of DM2 — sodium-glucose cotransporter 2 inhibitors (SGLT2i) — has proven to be a breakthrough. These inhibitors combine proximal tubule diuretic and osmotic action leading to a reduction in glucose reabsorption, and mild natriuretic and diuretic effects. Following up on these unique effects, several studies showed that treatment with SGLT2i may not only increase the efficacy of standard antidiabetic therapy, but also reduce CVD and HF mortality [5–8]. Until now, the utilization of SGLT2i in Poland has been relatively limited, which has meant there is a lack of experience in their usage, and underutilization in the treatment of patients. Herein, a study with this novel class of drugs is reported in a cohort of 52 Polish DM2 patients with CVD, including a large proportion of patients with HF, all of whom were prescribed SGLT2i. A retrospective analysis was performed that included 52 diabetic outor inpatients, who agreed to treatment with SGLT2i between 2017 and 2019. At baseline, all patients underwent a detailed diagnostic work-up: clinical evaluation, blood tests (including NT-proBNP, fasting glucose, HbA1c, cholesterol LDL and creatinine levels), electrocardiogram and echocardiography. Telephone contact or outpatient visits were carried out in December 2019 and January 2020. The investigation conforms to the principles outlined in the Declaration of Helsinki. All parameters are presented as means ± standard deviation or counts (percentages) when appropriate. All variables were tested for normal distribution of data with the Shapiro-Wilk test. Comparisons of continuous parameters between patients with and without HF were conducted with t-tests when normality was confirmed, or otherwise, with the Mann-Whitney test; the c test was performed for the comparison of qualitative parameters. All results were considered statistically significant when their p-value was < 0.05. The Statistica package, version 13.0 (StatSoft, TIBCO Software Inc.), was used for the statistical analysis. Out of 52 patients 50 (96%) received empagliflozin and 2 (4%) dapagliflozin. Most patients (40; 77%) were also treated with metformin, 15 (29%) received insulin and 10 (19%) sulphonylurea. Patients were stratified into those with HF (36.7%) and those without HF (16.3%) (Table 1). Both groups were burdened with a high number