Anti-Diabetic Therapy, Heart Failure and Oxidative Stress: An Update

Ioanna Koniari, Dimitrios Velissaris, Nicholas G. Kounis, Eleni Koufou, Eleni Artopoulou, Cesare de Gregorio, Virginia Mplani, Themistoklis Paraskevas, Grigorios Tsigkas, Ming Yow Hung, Panagiotis Plotas, Vaia Lambadiari, Ignatios Ikonomidis

Research output: Contribution to journalReview articlepeer-review

5 Citations (Scopus)


Diabetes mellitus (DM) and heart failure (HF) are two chronic disorders that affect millions worldwide. Hyperglycemia can induce excessive generation of highly reactive free radicals that promote oxidative stress and further exacerbate diabetes progression and its complications. Vascular dysfunction and damage to cellular proteins, membrane lipids and nucleic acids can stem from overproduction and/or insufficient removal of free radicals. The aim of this article is to review the literature regarding the use of antidiabetic drugs and their role in glycemic control in patients with heart failure and oxidative stress. Metformin exerts a minor benefit to these patients. Thiazolidinediones are not recommended in diabetic patients, as they increase the risk of HF. There is a lack of robust evidence on the use of meglinitides and acarbose. Insulin and dipeptidyl peptidase-4 (DPP-4) inhibitors may have a neutral cardiovascular effect on diabetic patients. The majority of current research focuses on sodium glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists. SGLT2 inhibitors induce positive cardiovascular effects in diabetic patients, leading to a reduction in cardiovascular mortality and HF hospitalization. GLP-1 receptor agonists may also be used in HF patients, but in the case of chronic kidney disease, SLGT2 inhibitors should be preferred.

Original languageEnglish
Article number4660
JournalJournal of Clinical Medicine
Issue number16
Publication statusPublished - Aug 2022


  • diabetes
  • dipeptidyl peptidase 4 inhibitors
  • glucagon-likepeptide-1 receptor agonists
  • heart failure with preserved ejection fraction (HFpEF)
  • heart failure with reduced ejection fraction (HFrEF)
  • metformin
  • oxidative stress
  • SGLT2 inhibitors
  • sulfonylureas
  • thiazolidinediones

ASJC Scopus subject areas

  • General Medicine


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