Type 2 diabetes and heart failure: insights from the global DISCOVER study

Area of Science:

• Cardiology
• Endocrinology
• Epidemiology

Background:

• Type 2 diabetes (T2D) significantly increases the risk of heart failure (HF), a leading cause of morbidity and mortality.
• The global epidemiology and management of HF in T2D patients require further elucidation.

Purpose of the Study:

• To investigate the global prevalence and 3-year incidence of heart failure (HF) in patients with type 2 diabetes (T2D).
• To analyze HF occurrence in T2D patients with and without co-existing coronary artery disease (CAD).

Main Methods:

• The DISCOVER study was a 3-year prospective, observational study involving 14,057 T2D patients across 36 countries initiating second-line glucose-lowering therapy.
• Baseline HF prevalence was assessed, and HF incidence was determined over 3 years in a subset of 9,313 patients with follow-up data.

Main Results:

• At baseline, 2.1% of T2D patients had HF. Patients with HF were older, had longer T2D duration, and higher rates of CAD, atrial fibrillation, and kidney disease.
• The incidence of HF was 2.6 cases per 1000 person-years. Notably, 60% of incident HF cases occurred without prior or concurrent CAD, and 73% were diagnosed in outpatient settings.

Conclusions:

• A substantial proportion of incident heart failure in type 2 diabetes patients occurs without known coronary artery disease.
• These findings underscore the critical need for increased awareness and proactive screening for HF risk in the T2D population, particularly in outpatient settings.