Sodium–glucose cotransporter 2 inhibitors (SGLT2i) reduce heart failure (HF) risk in people with type 2 diabetes mellitus (T2DM), although most individuals with T2D do not have established atherosclerotic cardiovascular disease (ASCVD), HF, or chronic kidney disease (CKD). A study published in Diabetes Care, developed and validated the SGLT2i Absolute Benefit Response (SABRE) model to estimate individualized HF prevention benefit with SGLT2i in this broader population.

The SABRE model combined baseline HF risk from the validated QDiabetes-HF model with treatment effect estimates derived from a trial meta-analysis. Validation used United Kingdom primary care data linked to hospital admission and mortality records collected between 2013 and 2020.

The analysis included 57,368 SGLT2i initiators and 111,673 comparator initiators receiving either dipeptidyl peptidase 4 inhibitors or sulfonylureas.

Findings

• SGLT2i use was associated with a 30% lower risk of new-onset HF compared with comparator therapies (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.63-0.78).
• Relative HF benefit with SGLT2i did not vary according to baseline HF risk (P = 0.82).
• The SABRE model predicted a 5-year absolute HF benefit ranging from less than 0.1% to 14.1%, with a median predicted benefit of 1.0% (interquartile range, 0.6%-1.8%).
• Model predictions demonstrated good calibration against observed HF outcomes in the validation cohort.
• The SABRE model provided more targeted HF prevention estimates than current guideline-based approaches among people with T2D without ASCVD, HF, or CKD.

The SABRE model estimated individualized HF prevention benefits with SGLT2i among people with T2D without established cardiovascular or kidney disease. The findings support a more targeted approach for identifying individuals who may derive greater HF benefit from SGLT2i therapy.