SGLT2 inhibitor benefit was the same above and below a BMI of 30

Design

Meta-analysis of randomised placebo-controlled trials, BMI-stratified

Population

8 trials, 57,356 patients with heart failure, CKD and/or type 2 diabetes

Primary outcome

Cardiovascular death or heart failure hospitalisation

Effect

BMI <30 RR 0.80 (0.72 to 0.89); BMI ≥30 RR 0.80 (0.75 to 0.85)

A meta-analysis pooled eight placebo-controlled trials of SGLT2 inhibitors in heart failure, chronic kidney disease or type 2 diabetes (57,356 patients) that reported results by BMI below or above 30.

Cardiovascular death or heart failure admission fell by 20% in both groups (RR 0.80 below 30, 0.80 at 30 or above), with no effect modification. Heart failure admission (RR 0.75 and 0.74) and all-cause death (0.83 and 0.89) were also reduced in both. Heterogeneity came from disease type and drug, not BMI.

Many Indian patients with CKD or diabetes have a BMI well under 30, and prescribers sometimes hesitate over weight loss or volume depletion in leaner patients. These data show the benefit does not depend on obesity.

• Offer SGLT2 inhibitors for CKD, heart failure or diabetes regardless of BMI
• In lean or frail patients, review diuretic dose when starting
• Warn about genital hygiene and sick-day rules
• Expect and accept a small early eGFR dip

Why it matters

It removes body size as a reason to hesitate over a drug with proven organ protection.

Don't overread it

The BMI cut-off of 30 is coarse, and very low BMI groups were not analysed separately.

The statistics, in plain English

Identical risk ratios of 0.80 in both BMI groups, with no significant interaction, mean the relative benefit did not differ. An interaction test asks whether two subgroup effects differ from each other, which is the right question here, rather than whether each is significant on its own.

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