SGLT2 Inhibitors, Ketones, and Cardiovascular Benefit Research Plan

This study investigates how a class of diabetes medications called SGLT2 inhibitors (such as empagliflozin or dapagliflozin) benefit the heart in people with both type 2 diabetes and heart failure. Researchers believe the benefit may come from these drugs raising ketone levels in the blood, which the heart uses as an efficient fuel source. **You may be eligible if...** - You have type 2 diabetes and heart failure with reduced pumping function - You are aged 18–80 with a BMI between 23 and 38 - Your blood pressure is controlled (at or below 145/85) - Your kidney function is adequate (eGFR ≥ 30) - Your blood sugar (HbA1c) is between 5.5% and 10% - You have been on stable medications for at least 3 months **You may NOT be eligible if...** - You are already taking an SGLT2 inhibitor, GLP-1 receptor agonist, or pioglitazone - You are pregnant, breastfeeding, or planning to become pregnant - You have cancer or active drug/alcohol dependence - You have severe claustrophobia or cannot have an MRI (e.g., pacemaker, metal implants) Talk to your doctor to see if this trial is right for you.