Cardiovascular outcome trials have shown that drugs called SGLT-2 inhibitors help in reducing CV mortality for heart failure in people with Type 2 Diabetes (T2D). In an earlier study, we found that SGLT-2 inhibitors can increase (30%) the coronary flow reserve (CFR) in T2D patients with stable coronary artery disease (CAD). This study aims to assess the long-term impact of dapagliflozin medication on CFR in T2D patients. 

A study had been done followed up with the T2D patients with CAD who participated in a single centre, four-week, prospective, randomized (1:1 dapagliflozin 10 mg or placebo), double-blind, controlled study for four years. At the end of the earlier study, all the patients in the placebo group (who were not taking SGLT-2 inhibitors) started taking dapagliflozin (an SGLT-2 inhibitor). After four years of treatment, we measured the CFR using 13N-ammonia PET-CT in all the patients.

Throughout the follow-up, the antidiabetic medications were consistent. In the DAPA group (n=5), a 30% rise in CFR remained constant over four years (p=NS). The analysis of pre- and post-4-year monitoring in the DAPA group revealed a 35% rise in CFR (p = 0.09). Following four years of dapagliflozin medication, the placebo group (n=4) showed a 28.6% rise in CFR (p=0.07). In general, following four years of treatment, all patients had a 25% rise in CFR (p=0.008, n=9), as well as a decrease in myocardial resting blood flow (p=0.002, n=9), as seen in the DAPAHEART experiment.

This four-year monitoring trial reveals that the 30% rise in CFR acquired after four weeks of therapy remains stable following four years, verifying the previously reported results in a new cohort. This improvement in CFR may have important implications for the management and prognosis of patients with Type 2 Diabetes and coronary artery disease.

140-OR: American Diabetes Association (ADA) 84th Scientific Sessions, 2024, 21- 24 June 2024, Orlando, Florida.