Clinical Efficacy Of Dapagliflozin In Elderly Patients With Type 2 Diabetes Mellitus Combined With Heart Failure With Preserved Ejection Fraction

Objective: To observe the effects of dapagliflozin on in-hospital diuretic dosage,quality of life and related clinical parameters in elderly patients with type 2 diabetes mellitus(T2DM)combined with heart failure with preserved ejection fraction(HFpEF).The study aims to provide a safe and effective treatment option for elderly patients with T2 DM combined with HFpEF,and to improve the quality of life of the combined frail patients.Methods: One hundred and forty elderly patients who were hospitalized for T2 DM combined with HFpEF in the Department of Geriatrics of the First Hospital of Hebei North College from March 2021 to March 2022 were selected,and the patients were divided into control group and observation group by random number table method,with 70 patients in each group.Patients in the control group received standard hypoglycaemic and heart failure improvement therapy,while patients in the observation group(dapagliflozin group)received 10 mg of dapagliflozin daily in addition to the standard therapy for more than 6 months.The N-terminal pro-b-type natriuretic peptide(NT-proBNP),C-reactive protein(CRP)and estimated glomerular filtration rate(eGFR)were measured before and after treatment in both groups.The indicators of frailty were assessed and the Minnesota living with heart failure questionnaire(MLHFQ)score was administered.Total diuretic dosage at discharge was recorded and patients were followed up for the incidence of death,re-visits for heart failure and adverse events within 6 months after discharge.Independent samples t-test or rank sum test was used to compare the between-group differences in diuretic use,NTproBNP,eGFR,CRP and MLHFQ scores after treatment between the two groups,and paired samples t-test or rank sum test was used to compare the within-group differences in NT-proBNP,eGFR,CRP and MLHFQ scores before and after treatment between the two groups,using X~2 test or Fisher’s exact test to compare the differences in adverse effects and the incidence of death and re-visits for heart failure after discharge.Results:1.There were no statistically significant differences in clinical baseline characteristics such as gender,age,NYHA classification and debilitating or non-debilitating between the two groups before treatment(P>0.05).Nine patients were excluded during follow-up due to missed visits and discontinuation of medication,and a total of 131 patients were included for statistical analysis.2.In-hospital diuretic use was significantly reduced in the dapagliflozin group compared to the control group,with a statistically significant difference(P<0.001).3.After 6 months of treatment,patients in the dapagliflozin group had lower NT-proBNP and CRP levels than those in the control group,and the difference was statistically significant(P<0.001).The difference in eGFR between the two groups after treatment was not statistically significant(P=0.557).4.After 6 months of treatment,the MLHFQ scores of patients in the dapagliflozin group with frailty decreased significantly compared to the control group,with a statistically significant difference(P<0.001).5.Patients in the dapagliflozin group had a statistically significant difference in the incidence of death and re-visits for heart failure over 6months of treatment compared to the control group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions during medication between the two groups(P>0.05).Conclusions:Dapagliflozin can reduce in-hospital diuretic dosage in elderly patients with T2 DM combined with HFpEF,can reduce NT-proBNP and CRP levels,improve the quality of life in those with combined frailty,reduce the incidence of death and re-visits to the hospital for heart failure,and has a high drug safety profile.