Canagliflozin may reduce myocardial fibrosis in high-risk type 2 diabetes
Last updated June 2, 2026
Key finding
In a 26-week randomized trial, canagliflozin reduced CMR-measured myocardial extracellular volume and improved some left ventricular structural measures versus sitagliptin in adults with type 2 diabetes at high cardiovascular risk.
This trial compared canagliflozin with sitagliptin in adults with type 2 diabetes and high cardiovascular risk. Over 26 weeks, canagliflozin lowered a cardiac MRI marker linked to myocardial fibrosis and improved some measures of heart structure, while blood sugar lowering was similar in both groups.
Quick read
Study at a glance
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EvidenceScore™
Moderate
Study type
Randomized Controlled Trials (RCTs)
Follow-up
Medium-Term (3–12 mo)
Risk of bias
Some Concerns
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Plain-language summary
What this paper says
A plain-language read of the study’s main message and where it applies.
Study focus
In a 26-week randomized trial, canagliflozin reduced CMR-measured myocardial extracellular volume and improved some left ventricular structural measures versus sitagliptin in adults with type 2 diabetes at high cardiovascular risk.
Published in
Journal Reference
Publication details and source links for this paper.
Yan H, Liu J, Zhang Z, et al. Canagliflozin attenuates CMR-quantified myocardial fibrosis in individuals with type 2 diabetes mellitus at high cardiovascular risk: a randomised open-label controlled trial. Diabetologia. 2026;69(6):1532-1544. doi:10.1007/s00125-026-06682-w
Main Effects
Canagliflozin ↓ myocardial extracellular volume versus sitagliptin at 26 weeks
Canagliflozin ↓ left ventricular end-diastolic volume and diameter
HbA1c ↓ similarly in both groups, with no clear between-group difference
Evidence Suggest
- Primary cardiac MRI fibrosis marker favored canagliflozin over active comparator
- Some structural remodeling measures improved, but systolic function measures did not clearly differ
- Cardiac effects appeared separate from glucose lowering because HbA1c reductions were similar in both groups
Who this applies to
Adults aged 18 to 75 years with type 2 diabetes
Keep in Mind
This was a 26-week study, so long-term durability is unknown
Between the Lines
- Small single-center trial with 45 randomized participants
- Open-label design may introduce bias despite blinded outcome assessment
- Main findings rely on surrogate imaging markers rather than clinical cardiovascular events
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