Summary: In a subanalysis of the DAPA-MI trial in patients without diabetes after myocardial infarction, dapagliflozin reduced new-onset type 2 diabetes regardless of baseline glucose or BMI, and lessened heart-failure symptom burden most in those with prediabetes.
PICO Summary
| Element | Detail |
|---|---|
| Population | 3425 eligible DAPA-MI participants after myocardial infarction without type 2 diabetes (normoglycaemic or prediabetes). |
| Intervention | Dapagliflozin 10 mg daily. |
| Comparison | Placebo, stratified by baseline HbA1c and BMI. |
| Outcome | New-onset type 2 diabetes fell with dapagliflozin in normoglycaemia (0.6% vs 1.6%; HR 0.40) and prediabetes (10.1% vs 13.1%; HR 0.74), regardless of HbA1c or BMI. Greater reduction in NYHA class III–IV symptoms in prediabetes than normoglycaemia (interaction p=0.009). One-year absolute risk reductions reached 8.1% (new diabetes) and 10.0% (NYHA III–IV) in those with both prediabetes and BMI ≥30. |
Dapagliflozin after MI in patients without diabetes (DAPA-MI subanalysis)
RCT subanalysis · post-MI, no diabetes · 1 year
Dapagliflozin cut new-onset type 2 diabetes after myocardial infarction regardless of baseline HbA1c or BMI, with the reduction significant in prediabetes. Heart-failure symptom benefit was greatest in those with prediabetes.
Expert Commentary
This is a useful subanalysis that extends the SGLT2-inhibitor story into a population we do not usually think of as candidates, post-infarction patients who do not yet have diabetes. Two findings stand out. First, dapagliflozin reduced the development of new type 2 diabetes across the board, independent of starting HbA1c or BMI, which positions it as potentially diabetes-preventive in a high-risk cardiac group, not merely glucose-lowering in established disease. Second, the heart-failure symptom benefit was concentrated in those with prediabetes, and the absolute risk reductions in the prediabetes-plus-obesity subgroup, around 8% for new diabetes and 10% for advanced symptoms, are clinically substantial. The honest caveats: these are prespecified subgroup analyses with interaction tests, new-onset diabetes is partly defined by an HbA1c threshold that the drug itself influences, and event numbers in the smaller strata are limited. Can I use this with my patients? Cautiously and in context. It supports considering an SGLT2 inhibitor after myocardial infarction in patients with prediabetes and obesity for both symptomatic and metabolic benefit, while recognising the parent trial and guidelines, not this subanalysis alone, define the indication.
References
Storey RF, Deanfield J, James S, et al. Impact of dapagliflozin on cardiometabolic outcomes after acute myocardial infarction according to baseline glycemic status and body mass index: subanalyses of the DAPA-MI trial. J Am Heart Assoc. 2025;14(15):e040327. doi:10.1161/JAHA.124.040327