Uso de inhibidores SGLT2 en el manejo de pacientes diabéticos con insuficiencia cardiaca.

Abstract

Type 2 diabetes mellitus (T2DM) and heart failure (HF) are two chronic diseases with a bidirectional relationship and a significant impact on morbidity and mortality. Patients with T2DM have an increased risk of developing HF, and this association complicates their clinical management. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have emerged as a promising therapeutic option, not only for their glucose-lowering effect but also for their cardiovascular and renal benefits. This review aims to synthesize the current evidence on the use of SGLT2i in patients with T2DM and HF, evaluating their efficacy, safety, and mechanisms of action to contribute to the optimization of the comprehensive management of these conditions. Objective: To analyze the use of SGLT2 inhibitors in the management of diabetic patients with heart failure. Methods: This study is a descriptive and documentary systematic review based on the PRISMA methodology, analyzing scientific articles from indexed databases and official health sources. Results: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown efficacy in the treatment of type 2 diabetes and heart failure by blocking renal glucose reabsorption, reducing volume overload, and improving cardiac function. Additionally, they optimize myocardial metabolism by promoting the use of ketone bodies and attenuating neurohormonal activation. They also exhibit nephroprotective effects, slowing the progression of renal damage and reducing hospitalizations and cardiovascular mortality. Drugs such as empagliflozin, dapagliflozin, canagliflozin, and ertugliflozin have been evaluated in key clinical trials, showing greater benefit in heart failure with reduced ejection fraction. However, they may cause adverse effects like diabetic ketoacidosis, urinary infections, and an increased risk of amputations, requiring monitoring in patients with advanced renal failure or at risk for complications. Conclusions: SGLT2 inhibitors have demonstrated efficacy in patients with type 2 diabetes and heart failure, improving glycemic control, enhancing cardiac function, and reducing hospitalizations and mortality. Their mechanism of action promotes glucose and sodium excretion, alleviating volume overload and optimizing cardiac efficiency. Among them, empagliflozin and dapagliflozin stand out for their effectiveness. Although they pose risks such as ketoacidosis and urinary infections, their clinical benefits justify their use under appropriate monitoring.