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To reduce HF-related outcomesa in all patients with T2DM

and HF (HFpEF, HFmrEF, HFrEF)

SGLT2 inhibitorb

(Class I) Independent of HbA1c

Independent of concomitant glucose-lowering medication

For additional glucose control

Metformin (Class lla) Insulin glargine Insulin degludec

(Class lla)

Sitagliptin Linagliptin (Class lla)

GLP-1 RAc (Class lla)

Other glucose-lowering agents with neutral effects on HF

in CVOTs should be considered

Pioglitazone

(Class III) Saxagliptin

(Class Ill)

Other glucose-lowering agents with increased risk for HF

hospitalization in CVOTs are not recommended

Figure 16 Glucose-lowering treatment of patients with heart failure and type 2 diabetes. CVOT, cardiovascular outcomes trial; DPP-4, dipeptidyl peptidase-4; GLP-1 RA, glucagon-like peptide-1 receptor agonist; Hb1Ac, glycated haemoglobin; HF, heart failure; HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; SGLT2, sodium–glucose co-transporter-2; T2DM, type 2 diabetes mellitus. aThis includes HF hospitalization or CV death. bEmpagliflozin, dapagliflozin, or sotagliflozin in patients with HFrEF, empagliflozin or dapagliflozin in patients with HFpEF and HFmrEF. cPreferred in patients with atherosclerotic cardiovascular disease and if weight reduction is needed; do not combine with DPP-4 inhibitors.

ESC Guidelines                                                                                                                                                                                          4095

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