Diabetes drugs reduce heart failure risk linked to diabetes, study finds

SINGAPORE - A class of drugs used to treat Type 2 diabetes here has been found to reduce the risk of hospitalisation for heart failure, which can be linked to diabetes, by nearly 40 per cent, according to an international study.

Diabetes can cause large and small vessel disease and an increased risk of blood clotting, which can then result in heart failure.

Published in May, the study also found that these drugs, called sodium-glucose co-transporter 2 inhibitors, or SGLT-2 inhibitors, reduced mortality from any cause by more than half.

The inhibitors included Dapagliflozin, an oral medication which removes excess glucose from the body. It was one of 11 drugs in a list for which guidances were issued by the Agency for Care Effectiveness (Ace) in May and is subsidised under the Medication Assistance Fund.

Diabetes is a condition where there is high blood sugar level. People with Type 2 diabetes experience insulin resistance, in which their body's cells and tissues are unable to respond to insulin. Insulin enables the body to store and use glucose from food.

Diabetes affects more than 400 million adults worldwide. People with Type 2 diabetes have a two to three times greater risk of heart failure.

In 2014, about 440,000 Singaporeans aged 18 years old and above had diabetes, and it is the second leading cause of morbidity and mortality in Singapore. A separate study published last year found that nearly 60 per cent of heart failure patients here had diabetes. The Ministry of Health declared war on diabetes in April last year.

The study was based on data from 300,000 patients from Denmark, Norway, Sweden, Britain, United States and Germany from 2012 to 2016.

One Dapagliflozin tablet costs $1.36 before the subsidy, with the subsidy shaving off half to 3/4 of the cost.

It is usually taken in combination with one or more oral drugs, such as Metformin, to treat diabetes, if those drugs are not working or have adverse side effects.

The study is still relevant to the Singapore context, said Adjunct Associate Professor Tan Ru San, senior consultant at the Department of Cardiology at the National Heart Centre Singapore (NHCS).

"In South-east Asia, we have a higher risk of diabetes and we develop heart failure earlier...due to our carbohydrate-rich diet, (how) our lifestyle is very sedentary, and (how) smoking is still such a huge problem," said Prof Tan.

He added that the mortality rate of the average of 500 patients with heart failure admitted to the NHCS each year from 2008 to 2015 was about 2 per cent.