This study states that Patients with type 2 diabetes mellitus (T2DM) are at high risk for heart failure (HF).1–4 The lifetime adjusted cumulative hazard for incident HF in patients with T2DM, hypertension, and obesity with an index age of 55 years reaches 60%.5 Moreover, patients with T2DM represent a substantial proportion of patients hospitalized for HF. In a large global registry, patients with history of atherothrombosis and T2DM had a 30% greater risk of hospitalization for HF (HHF) than patients with atherothrombosis but without T2DM.6 In a large European registry, T2DM was prevalent in approximately one-half of all patients admitted for HF in 1 year at 211 cardiology centers.7 In comparison with those patients without diabetes, patients with diabetes had higher cumulative rates of in-hospital and 1-year mortality, and 1-year HF rehospitalization, even when adjusting for multiple clinical risk factors.7

Results from clinical outcome trials with glucose-lowering therapies have yielded mixed results with regard to effects on HF risk, with some increasing, many neutral, and some decreasing risk.8 Six clinical outcome trials with 4 different sodium-glucose cotransporter 2 (SGLT2) inhibitors in patients with T2DM, including VERTIS CV (Evaluation of Ertugliflozin Efficacy and Safety Cardiovascular Outcomes Trial) with ertugliflozin, have demonstrated consistent reduction in risk for first HHF.