Background: Gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) represent two different components of the spectrum of diabetes mellitus (DM). Women with GDM have a high chance of developing T2DM in later life and this relative risk depends on a number of factors including ethnicity. Aim: To compare and estimate the risk of developing T2DM in South Asian women with a history of GDM compared to those without a history of GDM. Methods: This is a systematic review of PubMed and MEDLINE articles reporting the progression of GDM to T2DM that were published in English from 2000 to 2020. We performed meta-analysis to calculate risk ratios (RR). Results: We selected 6 studies considering the inclusion and exclusion criteria after sorting 25 full-text articles. Of the 44165 South Asian women assessed, 3095 had GDM and 41070 were without GDM. 995 women in GDM group and 1525 women in non-GDM group had developed T2DM. The RR of women with GDM over non-GDM in developing T2DM was 10.81 (95% confidence interval (CI): 7.61–15.35) suggesting that women with GDM are at 10.81 times more risk of developing T2DM than non-GDM. The cumulative incidence of T2DM in GDM group was 17.34% at 5 years of follow-up and 33% at more than 10 years of follow-up. Conclusion: The risk of developing T2DM in later life is higher in South Asian women with GDM than without GDM. Therefore, lifestyle and pharmacological interventions, patient communication, timely screening, and long-term follow-up of GDM patients are important to reduce the risk.

Diabetes mellitus is present in more than two-fifths of the patients suffering from heart failure (HF), with the incidence being more than twice that found in the non-diabetic population. It doubles the risk of hospitalization and increases the risk of fatal outcomes, thus negatively affecting the prognosis in HF patients. The available pharmacological treatment options are limited, particularly in HF with preserved ejection fraction (EF). Empagliflozin is a sodium-glucose transporter-2 inhibitor, which has shown a protective effect against cardiomyocyte dysfunction through various mechanisms. The benefits of empagliflozin has been seen in multiple studies: EMPA-REG (April 2015), EMPRISE (June 18, 2019), EMPIRE-HF (2019), EMPA-AHF-RESPONSE (January 7, 2020), The EMPEROR Reduced (May 28, 2020), The RECEDE-CHF (November 3, 2020), SUGAR-DM (February 9, 2021), and EMPEROR-Preserved (April 26, 2021). Empagliflozin reduced the risk of all-cause mortality, HF hospitalizations, and biomarkers in patients with HF both with reduced and preserved EF in prospective and retrospective studies, regardless of the presence of diabetes. Linagliptin is a DPP-4i that has demonstrated renal safety with potential albuminuria benefits as well. Both these agents in combination have shown favorable effects on elevated blood pressure and intima-media thickness. Unlike some other gliptins, linagliptin was not associated with an increased risk of HF, rather a nominal reduction noted in CARMELINA (January 18, 2018). When added to the standard of care, it reduced the dose of insulin in high-risk diabetic patients with HF. The risk of hypoglycemia is significantly less in patients treated with linagliptin compared with sulfonylurea regimen as seen in CAROLINA (August 21, 2018). Thus, considering the plethora of clinical benefits demonstrated, a combination of empagliflozin and linagliptin in patients of diabetes at high risk of HF may be a suitable option for primary and secondary prevention.