European journal of preventive cardiologyOct 5, 2023

Health outcomes of diabetes drugs that remove sugar through urine in patients with irregular heartbeat and type 2 diabetes

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Updated Mar 26, 2026

Abstract

In a study of 11,012 patients with both atrial fibrillation and type 2 diabetes mellitus, the incidence of death or hospitalization due to heart failure was 8.4% in those using sodium-glucose cotransporter-2 inhibitors (SGLT2is) compared to 14.6% in non-users.

SGLT2is use was associated with a lower risk of death or hospitalization due to heart failure over a 3-year period.
The hazard ratio for the primary endpoint in the SGLT2i group was 0.69, indicating a significant reduction in events.
All-cause mortality was significantly lower in patients using SGLT2is, with a hazard ratio of 0.43.
Hospitalization for heart failure was also reduced in the SGLT2i group, with a hazard ratio of 0.77.
Adverse renal events occurred less frequently in the SGLT2i group, with a hazard ratio of 0.50.

Simplified

AIMS: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have been shown to improve cardiovascular outcomes and reduce the incidence of atrial fibrillation (AF) in patients with type 2 diabetes mellitus (T2DM). We investigated the clinical outcomes with and without the use of SGLT2is in patients with T2DM and concomitant AF.

METHODS AND RESULTS: We derived patient data from a clinical data warehouse constructed from the electronic medical records of seven medical centres. Data for 11 012 patients diagnosed with both AF and T2DM were analysed. New SGLT2i users were classified into the SGLT2i group and those who were not prescribed SGLT2is were classified into the control group. We performed a 1:2 propensity score (PS)-matching analysis. The primary endpoint was a composite of all-cause death or hospitalization due to heart failure (HF) events in 3 years. The PS-matched population consisted of 1115 patients in the SGLT2i group and 2050 patients in the control group. Incidence of the primary endpoint was significantly lower in the SGLT2i group [8.4 vs. 14.6%, hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.55-0.87]. Sodium-glucose cotransporter-2 inhibitors use was associated with significantly lower all-cause mortality (HR 0.43, 95% CI 0.29-0.67) and HF hospitalization (HR 0.77, 95% CI 0.59-0.99). Adverse renal events, defined as >50% increase in serum creatinine level or initiation of dialysis, occurred less often in the SGLT2i group (HR 0.50, 95% CI 0.38-0.66, P < 0.001).

CONCLUSION: Use of SGLT2is in patients with T2DM and concomitant AF was associated with reduced mortality or HF hospitalization events.

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Health outcomes of diabetes drugs that remove sugar through urine in patients with irregular heartbeat and type 2 diabetes

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