In the cardiac wards of Khartoum, a quiet but consequential question was being answered: does a drug proven in wealthy clinical trials hold its promise when given to real patients in a resource-constrained world? Between April and July of 2022, 238 Sudanese adults living with heart failure offered that answer through their own experience with dapagliflozin — and the evidence that emerged places a powerful therapy within reach of populations long excluded from the evidence base that shapes global medicine.
Dapagliflozin shows promise in Sudanese heart failure patients, first real-world data
Their hearts got better. The evidence is now on the record.
Mark
So this is the first time anyone has actually looked at whether dapagliflozin works in Sudan specifically?
Mimi
Yes. The drug has been studied extensively in large trials in wealthy countries, but no one had documented how it performs in routine Sudanese practice until this study.
Luke
How long were patients followed? The study period was April to July 2022—that's four months. We don't know what happened to these people after that.
Mark
What made the adherence rate so high? Eighty-six percent is genuinely impressive.
Mimi
The researchers didn't dig into the reasons, but the fact that people stuck with it despite side effects like increased urination suggests they felt it was worth taking.
Luke
We should be careful here. High adherence was "reported"—that's patient self-report, not pharmacy refill data or pill counts. We don't know if that's actually what happened.
Mark
The heart function improvement—five and a half percentage points—is that big?
Mimi
For heart failure patients, any sustained improvement in ejection fraction is meaningful. It means the heart is pumping more efficiently.
Luke
But we don't have a control group. We don't know if these patients would have improved anyway, or if other treatments they were receiving contributed to the change.
Mark
What about the deaths? Four and a half percent seems low.
Mimi
It is relatively low, and it suggests the drug is doing its job. But remember, this is a four-month window in a selected population at cardiac hospitals.
Luke
Exactly. These are people sick enough to be at specialized cardiac centers. We don't know how the drug performs in primary care or in sicker populations. And four months is too short to draw firm conclusions about mortality benefit.
Der Puls
- Heart failure remains a leading cause of death in low-resource settings where access to evidence-backed therapies is uneven and clinical trial data rarely reflects local populations.
- Dapagliflozin's known side effects — frequent urination in two-thirds of patients, urinary tract infections in one-third — created real discomfort, yet failed to erode a strikingly high adherence rate of 86%.
- The drug delivered measurable gains where it mattered most: ejection fraction rose by nearly 6 percentage points, and diabetic patients saw meaningful reductions in long-term blood sugar levels.
- Cardiovascular deaths and hospitalizations remained low, suggesting the treatment was actively holding back the disease's worst consequences in a setting with limited safety nets.
- The study's significance lies less in confirming that the drug works and more in proving it works here — generating the local, real-world evidence that clinicians in similar settings need to act with confidence.
In the cardiac wards of Khartoum, a quiet but consequential question was being answered: does a drug proven in wealthy clinical trials hold its promise when given to real patients in a resource-constrained world? Between April and July of 2022, 238 Sudanese adults living with heart failure offered that answer through their own experience with dapagliflozin — and the evidence that emerged places a powerful therapy within reach of populations long excluded from the evidence base that shapes global medicine.
In the spring and summer of 2022, researchers across three cardiac hospitals in Khartoum enrolled 238 adults who had been prescribed dapagliflozin as part of their ordinary heart failure care. Through medical records and structured interviews, they assembled the first real-world portrait of how this SGLT2 inhibitor performs in a Sudanese population — a population that had never before appeared in the evidence base for this class of drugs.
The patients were broadly representative of heart failure: average age just over 60, slightly more male than female, nearly all on the standard 10-milligram daily dose. What distinguished the cohort early was adherence — 86 percent reported taking the medication consistently, a figure that speaks to both the drug's tolerability and its perceived value in a setting where medication access is not always guaranteed.
Side effects were present and familiar. Two-thirds of patients experienced increased urination, and roughly one in three developed urinary tract infections — predictable consequences of how the drug clears glucose through the kidneys. Neither was trivial, but neither drove patients away from treatment.
The clinical results were meaningful. Among patients with paired cardiac measurements, ejection fraction improved by an average of nearly six percentage points — a statistically robust and clinically significant gain. Diabetic patients saw their three-month blood sugar averages fall by nearly a full percentage point. Cardiovascular deaths occurred in 4.6 percent of the cohort, and heart failure hospitalizations in 7.6 percent — rates that suggest the drug was actively limiting the disease's most serious consequences.
Large randomized trials had already established dapagliflozin's efficacy in controlled settings across wealthier nations. What this study adds is something different: evidence that the drug is safe, tolerable, and effective in a real Sudanese clinic, among patients navigating real barriers to care. That evidence is now on the record, and it meaningfully expands the case for bringing SGLT2 inhibitors into low-resource cardiac settings where they have long been underused.
Between April and July of 2022, researchers at three cardiac hospitals in Khartoum, Sudan, enrolled 238 adults who had been prescribed dapagliflozin for heart failure in their routine clinical practice. The patients were tracked through medical records and structured interviews, capturing everything from their basic demographics to what happened to them over time. What emerged was the first real-world picture of how this drug—a sodium-glucose cotransporter-2 inhibitor, or SGLT2 inhibitor—actually performs in a Sudanese population, where such evidence had never existed before.
The cohort was fairly typical for heart failure: mean age 60.7 years, 55 percent male. Nearly all of them, 96.3 percent, started on the standard 10-milligram once-daily dose. What stood out immediately was adherence. In a setting where medication access and consistency can be fragile, 86.1 percent of patients reported high adherence to the regimen. That number matters because it suggests the drug was tolerable enough, and perhaps valued enough, that people actually took it.
The side effects were real but manageable. Two-thirds of patients experienced polyuria—increased urination—which is a known consequence of how the drug works. About one in three developed urinary tract infections. These were not trivial complaints, but they were not severe enough to drive people away from treatment. No unexpected or catastrophic adverse events emerged from the data.
Where the drug showed its clinical weight was in the heart itself. Among 213 patients with paired measurements of left ventricular ejection fraction—the percentage of blood the heart pumps with each beat—the improvement was statistically significant and clinically meaningful. Ejection fraction rose by an average of 5.98 percentage points from baseline to follow-up. For patients with diabetes, blood sugar control improved as well: HbA1c, the three-month average of blood glucose, dropped by 0.91 percentage points among the 158 patients with paired measurements. Both changes were statistically robust.
The hard outcomes told a sobering but not unexpected story. Cardiovascular death occurred in 4.6 percent of the cohort. Heart failure hospitalization happened in 7.6 percent. These are the events that matter most to patients and clinicians—the moments when the disease overwhelms treatment and the person ends up in crisis. The rates were not zero, but they were low enough to suggest the drug was doing what it was supposed to do.
What makes this study significant is not that dapagliflozin works—large randomized trials in wealthy countries have already established that. What matters is that it works here, in Sudan, in a real clinic, with real patients who may not have perfect access to other treatments, who may face barriers to follow-up care, who live in a resource-constrained setting. The drug was safe. People took it. Their hearts got better. The evidence is now on the record, and it opens a door for clinicians in low-resource settings to consider this therapy as a genuine option in their toolkit for heart failure care.
Bemerkenswerte Zitate
Dapagliflozin was associated with good adherence, observed improvement in left ventricular ejection fraction, and an acceptable safety profile, supporting its role in cardiac care in low-resource settings.— Study conclusion
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