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Heart failure management; a perspective from diabetes care
1Clalit Health Services, Haifa, Israel.
Insights
Type 2 diabetes (T2DM) significantly increases heart failure (HF) risk. This review examines integrating HF prevention and management into routine diabetes care, highlighting new therapies like SGLT-2 inhibitors.
Area of Science:
- Endocrinology
- Cardiology
- Internal Medicine
Background:
- Individuals with type 2 diabetes (T2DM) face a 2-4 times higher risk of heart failure (HF).
- Traditional diabetes care prioritizes microvascular and arterial disease prevention, overlooking HF as a primary complication.
- Existing diabetes management strategies (glucose, BP, lipid control) indirectly benefit HF incidence.
Purpose of the Study:
- To review the integration of heart failure (HF) prevention and management into ambulatory diabetes care.
- To discuss the evolving role of diabetologists in addressing advanced complications like HF.
- To highlight recent therapeutic advancements impacting HF in diabetic patients.
Main Methods:
- Review of current clinical practices in ambulatory diabetes care.
- Analysis of the impact of existing and novel glucose-lowering therapies on HF.
- Perspective from diabetologists on clinical management strategies.
Main Results:
- Sodium glucose transporter inhibitors 2 (SGLT-2 inhibitors) demonstrate significant benefits in reducing HF hospitalizations, even in non-diabetic individuals.
- Renin-angiotensin system (RAS) blockers, commonly used in diabetes care, also contribute to HF prevention.
- The complexity and prevalence of T2DM have historically limited focus on advanced complications like HF.
Conclusions:
- There is a need to incorporate HF prevention and management more explicitly into routine diabetes care.
- Novel glucose-lowering agents, particularly SGLT-2 inhibitors, offer significant cardioprotective benefits.
- A collaborative approach between diabetologists and cardiologists is crucial for comprehensive patient management.
Abstract:
People with type 2 diabetes (T2DM) are recognized as having a 2-4 times increased risk of heart failure (HF). Ambulatory diabetes care has long concentrated on the prevention of microvascular and arterial disease, and surveillance for manageable problems such as with the feet and retinae. Accordingly, management of heart failure has never been a specific focus, although the preventative management of cardiac and kidney disease through glucose-lowering, blood pressure (BP) control, and blood lipid control, have had a positive impact on its incidence. Indeed, the very complexity of routine diabetes care, and its enormous prevalence, has generally excluded the management of any of the advanced late complications, whether cardiac, arterial, retinal, renal, or neurodegenerative. Furthermore, advances in HF management itself, in diagnostics, medications, and technology, has carried it deeper into the remit of specialist cardiological care. More recently and in addition to medications already routinely used in diabetes care such as renin-angiotensin system (RAS) blockers, some glucose-lowering therapies such as sodium glucose transporter inhibitors 2 (SGLT-2 inhibitors), have been found to have very positive effects on hospitalization for HF, indeed even in people who do not have T2DM. Here, from the perspective of the diabetologist, we review the clinical scenario of ambulatory diabetes care, in regard of how HF prevention and management should fit in to clinical practice.
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