Dapagliflozin Reduces Insulin Requirements at Discharge After CABG in Patients With T2D

Patients with type 2 diabetes (T2D) given dapagliflozin during hospitalization for coronary artery bypass graft (CABG) surgery required lower basal insulin and bolus insulin doses at discharge, according to recent research.¹

Presented at the Endocrine Society (ENDO) Annual Meeting 2026 in Chicago, Illinois, by Manasi Sanjiv Shah, MD, assistant professor at Virginia Health Sciences at Old Dominion University/Eastern Virginia Medical School, these data reflect significant support for the utilization of other SGLT2 inhibitors among similar populations.¹

Those with T2D make up roughly 1 in every 3 patients affected by cardiovascular disease, among which coronary heart disease is the most common and the primary cause of death in patients with T2D mellitus. Additionally, insulin resistance and hyperglycemia tied to T2D mellitus could lead to endothelial dysfunction and vascular complications, causing a worse prognosis. Patients with T2D mellitus also tend to have a higher rate of multivessel coronary stenosis, which can lead to plaque rupture, acute intracoronary thrombosis, and adverse clinical events.²

According to previous studies, patients with T2D undergoing CABG surgery are prone to worse prognoses after treatment, with diabetes increasing mortality risk by 1.85 folds in some cases. Altered glucose homeostasis and insulin resistance due to diabetes can result in over-inflammation, thereby triggering an increased expression of SLGT2 receptors. To this end, past studies have investigated the efficacy of various SGLT2 inhibitors like empagliflozin to reduce cardiovascular and all-cause mortality.²

In the present study, Shah and colleagues collected medical records of patients with T2D mellitus who underwent CABG surgery from 2019 to 2025 at the Old Dominion University hospital. A total of 765 patients were enrolled – of these, the 166 who received dapagliflozin during hospitalization were contrasted against the 599 who did not. Patients with prior use of SGLT2 inhibitors were included, but the team only examined the effects of dapagliflozin due to formulary restrictions.¹

Shah and colleagues implemented Chi-square, t-tests, and logistic regression to determine the relationship between inpatient SGLT2 inhibitor usage and baseline characteristics, insulin requirements, mean glucose values, occurrence of arrhythmias, 90-day readmission rates, and post-operative mortality.¹

The average age among the 765 included patients was 64 years, with a majority (N = 557) being male. The patient population had an average body mass index (BMI) of 31.3 kg/m². Among both cohorts, 97% of patients received insulin during their hospitalization, while 22% received dapagliflozin with mean initiation on post-operative day 3.¹

Shah and colleagues noted that, among variables studied, BMI, baseline creatinine, glargine, and lispro insulin dosing on the day before discharge, heart failure with preserved ejection fraction (HFpEF), and 90-day readmissions (P all <.05) had the greatest association with SGLT2 inhibitor use. In a multivariable logistic regression model, only HFpEF and baseline creatinine retained their significant association with dapagliflozin use following adjustment for covariates.¹

Patients with concomitant HFpEF were substantially less likely to receive dapagliflozin (odds ratio [OR], 0.48; P = .0458). Treatment with dapagliflozin also did not significantly impact mean glucose values, total and ICU lengths of stay, 90-day readmission rates, major arrhythmia occurrence during admission, or post-operative mortality.¹

Ultimately, Shah and colleagues concluded that patients with T2D who received dapagliflozin during hospitalization following CABG surgery needed lower insulin at discharge. On average, among the investigated patients, dapagliflozin initiation occurred roughly 3 days following surgery.¹

“While patients with HFpEF were less likely to receive this drug in our study, further studies are required in this specific population post-CABG surgery,” Shah and colleagues wrote.¹

References

1. Shah M, Bittner M, Ding E, et al. Effect of Dapagliflozin on Glycemic Management and Cardiovascular Outcomes in the Immediate Post-Operative Period in Patients with Type 2 Diabetes Mellitus (T2DM) Undergoing Coronary Artery Bypass Graft (CABG) Surgery. Abstract presented at the Endocrine Society (ENDO) Annual Meeting 2026, Chicago, IL. June 13-15, 2026.

2. Sardu C, Massetti M, Testa N, et al. Effects of Sodium-Glucose Transporter 2 Inhibitors (SGLT2-I) in Patients With Ischemic Heart Disease (IHD) Treated by Coronary Artery Bypass Grafting via MiECC: Inflammatory Burden, and Clinical Outcomes at 5 Years of Follow-Up. Front Pharmacol. 2021;12:777083. Published 2021 Nov 15. doi:10.3389/fphar.2021.777083