Fujimoto Yudai, Kida Keisuke, Suzuki Norio, Ide Tomomi, Matsushima Shouji, Kaku Hidetaka, Enzan Nobuyuki, Ikeda Masataka, Kitai Takeshi, Taniguchi Tatsunori, Okumura Takahiro, Tohyama Takeshi, Tsutsui Hiroyuki, Matsue Yuya
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Japan.
Clin Nutr ESPEN. 2025 Oct;69:767-774. doi: 10.1016/j.clnesp.2025.08.031. Epub 2025 Sep 2.
BACKGROUND & AIMS: It remains unclear whether sodium-glucose co-transporter-2 (SGLT2) inhibitors are effective for patients with underweight. This study aimed to elucidate the association between SGLT2 inhibitors use and prognosis in underweight patients with diabetes mellitus (DM) and HF.
This study was a post-hoc analysis of data from the Japanese Registry of Acute Decompensated Heart Failure, a prospective, multicenter, observational, nationwide registry. All hospitalized patients with HF decompensation requiring treatment were assessed for eligibility between April 2019 and April 2021. Patients with DM and body mass index (BMI) < 18.5 kg/m at discharge without a history of dialysis were included in this study. The patients were categorized into two groups based on SGLT2 inhibitor use at discharge. The main analysis relied on inverse probability of treatment weighting (IPTW) to balance the differences between the two groups, and the primary endpoint was 2-year all-cause mortality.
Of the 4016 patients registered from 87 hospitals, 178 underweight patients with HF and DM (mean age: 77 years, 57 % men, and mean BMI: 16.9 kg/m) were analyzed. Of them, 59 patients were on SGLT2 inhibitors at discharge while 119 patients were not. Compared with the patients in non-SGLT2 inhibitor group, those in SGLT2 inhibitor group were younger, more often men, and had a lower left ventricular ejection fraction and higher albumin levels. After IPTW, the patient characteristics were well balanced with all the standardized mean difference <0.2. Kaplan-Meier curves showed that the SGLT2 inhibitor group had a significantly lower incidence of mortality than the non-SGLT2 inhibitor group (14.7 % versus 33.3 %), which was mainly driven by the difference in cardiovascular death (6.4 % versus 18.8 %). The association between SGLT2 inhibitor use and lower mortality was maintained even after IPTW with additional regression adjustment (hazard ratio, 0.40; 95 % confidence interval 0.17-0.93; P = 0.033).
SGLT2 inhibitor use is associated with lower mortality in underweight patients with DM and HF.
钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂对体重过轻的患者是否有效仍不清楚。本研究旨在阐明SGLT2抑制剂的使用与体重过轻的糖尿病（DM）和心力衰竭（HF）患者预后之间的关联。
本研究是对日本急性失代偿性心力衰竭注册研究的数据进行的事后分析，该研究是一项前瞻性、多中心、观察性的全国性注册研究。2019年4月至2021年4月期间，对所有因心力衰竭失代偿需要治疗的住院患者进行了资格评估。本研究纳入了出院时体重指数（BMI）<18.5 kg/m²且无透析史的DM患者。根据出院时是否使用SGLT2抑制剂将患者分为两组。主要分析采用治疗权重逆概率（IPTW）来平衡两组之间的差异，主要终点是2年全因死亡率。
在87家医院登记的4016例患者中，分析了178例体重过轻的HF和DM患者（平均年龄：77岁，57%为男性，平均BMI：16.9 kg/m²）。其中，59例患者出院时使用SGLT2抑制剂，119例患者未使用。与非SGLT2抑制剂组的患者相比，SGLT2抑制剂组的患者更年轻，男性更多，左心室射血分数更低，白蛋白水平更高。经过IPTW后，患者特征得到了很好的平衡，所有标准化均值差异<0.2。Kaplan-Meier曲线显示，SGLT2抑制剂组的死亡率显著低于非SGLT2抑制剂组（14.7%对33.3%），这主要是由心血管死亡差异（6.4%对18.8%）驱动的。即使在进行IPTW并进行额外回归调整后，SGLT2抑制剂使用与较低死亡率之间的关联仍然存在（风险比，0.40；95%置信区间0.17-0.93；P = 0.033）。
SGLT2抑制剂的使用与体重过轻的DM和HF患者较低的死亡率相关。
