DECLARE-TIMI 58 Explained: Dapagliflozin, Heart Failure, and Kidney Protection

DECLARE-TIMI 58 tested dapagliflozin in more than 17,000 patients with type 2 diabetes and either established ASCVD or multiple cardiovascular risk factors. In this Nephrology Notebook episode, we break down the trial design, patient population, cardiovascular outcomes, heart-failure signal, renal composite results, safety findings, and practical prescribing implications. The key teaching point: dapagliflozin did not significantly reduce MACE in DECLARE-TIMI 58, but it significantly reduced cardiovascular death or hospitalization for heart failure, driven by fewer heart-failure hospitalizations, and showed favorable renal outcome signals. This trial helped shift diabetes care from glucose-only treatment toward cardiorenal risk reduction. Educational content only. Not a substitute for individualized medical advice. Designed for internal medicine residents, medical students, nephrology fellows, hospitalists, and clinicians Link to the article: https://www.nejm.org/doi/full/10.1056...