Precision Prescribing of SGLT2 Inhibitors for Primary Prevention of Heart Failure in Type 2 Diabetes
Heart failure is a major and often under-recognized complication of type 2 diabetes. Even in people who do not yet have established atherosclerotic cardiovascular disease, chronic kidney disease, or prior heart failure, diabetes itself raises the long-term risk of developing heart failure. Sodium-glucose cotransporter 2 inhibitors, or SGLT2 inhibitors, have changed diabetes care because they lower blood glucose and also provide cardiovascular and kidney benefits. However, the key clinical question is not simply whether these drugs work, but which patients with type 2 diabetes are most likely to benefit from them for preventing heart failure before it starts.
This study addressed that question by developing and validating a prediction model called SABRE, short for SGLT2i Absolute Benefit Response. The model combines an individual’s baseline risk of heart failure with the known relative benefit of SGLT2 inhibitors to estimate the absolute reduction in heart failure risk over 5 years. In practical terms, that means the model tries to answer: how much heart failure risk can be prevented for this specific person, not just for the average patient in a trial?
