Heart Failure in Type 1 vs. Type 2 Diabetes Mellitus: Shared Pathways, Distinct Challenges

Heart failure (HF) is a critical complication in both type 1 (T1D) and type 2 diabetes (T2D) and people with diabetes are at higher risk of developing HF than those without diabetes. The pathophysiology of HF in diabetes often involves diabetic cardiomyopathy, driven by insulin deficiency, insulin resistance (IR), inflammation, and myocardial fibrosis; however, though there are similarities in HF in T1D and T2D, there are also key differences in epidemiology, pathophysiology, treatment, and clinical outcomes. In this review article we will discuss the burden, pathophysiology, and outcomes of HF in diabetes, focusing on differences between T1D and T2D, and the relative unmet need for patients with T1D and HF.