Clinicians can reduce the risk of new-onset type 2 diabetes mellitus (T2DM) and improve heart failure (HF) symptom outcomes after myocardial infarction (MI) by prescribing dapagliflozin in patients without prior diabetes. A prespecified analysis of the randomized Dapagliflozin in Patients With Myocardial Infarction (DAPA-MI) trial, published in Journal of the American Heart Association, assessed 3,425 eligible participants without T2DM or chronic HF. The analysis excluded individuals without baseline hemoglobin A1c (HbA1c) data or not receiving study medication.

Participants were classified by HbA1c as normoglycemic (<5.7% [39 mmol/mol]) or prediabetic (5.7 to <6.5% [48 mmol/mol]) and by body mass index (BMI) as <25, 25 to <30, or ≥30 kg/m². In the normoglycemia group (n=1,926), dapagliflozin reduced new-onset T2DM incidence to 0.6% compared with 1.6% for placebo (hazard ratio [HR], 0.40; 95% confidence interval [CI], 0.15–1.03). In the prediabetes group (n=1,499), incidence decreased to 10.1% versus 13.1% (HR, 0.74; 95% CI, 0.55–0.99).
The greatest one-year absolute risk reductions occurred in participants with both prediabetes and BMI ≥30: 8.1% for T2DM and 10.0% for New York Heart Association (NYHA) class III–IV symptoms. Dapagliflozin provided consistent benefits across HbA1c and BMI categories, with the largest improvements in those with prediabetes and obesity.

Key takeaway: 

Post-MI patients with dysglycemia and/or obesity may benefit from early sodium-glucose cotransporter-2 (SGLT2) inhibitor initiation.