Congestive Heart Failure in Type 2 Diabetes

Abstract

OBJECTIVE -To estimate the prevalence and incidence of congestive heart failure (CHF) in populations with and without type 2 diabetes and to identify risk factors for diabetes-associated CHF.RESEARCH DESIGN AND METHODS -We searched the inpatient and outpatient electronic medical records of 9,591 individuals diagnosed with type 2 diabetes before 1 January 1997 and those of an age-and sex-matched control group without diabetes for a diagnosis of CHF. Among those without a baseline diagnosis of CHF, we searched forward for 30 months for incident cases of CHF. We constructed multiple logistic regression models to identify risk factors for both prevalent and incident CHF.RESULTS -CHF was prevalent in 11.8% (n ϭ 1,131) of diabetic subjects and 4.5% (n ϭ 435) of control subjects at baseline. We observed incident cases of CHF in 7.7% of diabetic subjects free of CHF at baseline (650 of 8,460) and in 3.4% of control subjects (314 of 9,156). In diabetic subjects, age, diabetes duration, insulin use, ischemic heart disease, and elevated serum creatinine were independent risk factors for both prevalent and incident CHF. Better glycemic control at baseline, and improved glycemic and blood pressure control at follow-up predicted the development of CHF.CONCLUSIONS -Despite controlling for age, duration of diabetes, presence of ischemic heart disease, and presence of hypertension, insulin use was associated with both prevalent and incident CHF. Why insulin use and better glycemic control both at baseline and follow-up independently predicted CHF deserves further study.

Diagnosis and Treatment of Incident Hypertension Among Patients with Diabetes: a U.S. Multi-Disciplinary Group Practice Observational Study

“…Our exclusion criteria (previous antihypertensive medication) decreased the prevalence of atrial fibrillation and congestive heart failure compared to previous observational studies. 43,44 Although this may limit the generalizability, our rates reflect a population of patients with diabetes and incident hypertension, and highlight the importance of a timely response to newly elevated blood pressures. Occasionally, patients are started on antihypertensive medication (e.g., ACE-inhibitor) due to a diagnosis of diabetes and not hypertension.…”

High cumulative insulin exposure: a risk factor of atherosclerosis in type 1 diabetes?

“…There is only circumstantial evidence that exposure to high levels of exogenous insulin adversely affects the risk of CVD [46][47][48][49][50][51][52]. The only observational study on this subject in patients with type 1 diabetes is the EDIC study, which is a follow-up study of the DCCT patients [15].…”

Incretin-Based Drugs and the Risk of Congestive Heart Failure

“…First, we excluded patients with a history of insulin or thiazolidinedione use prior to cohort entry and censored patients upon receiving these medications during follow-up, given their reported association with an increased risk of CHF (15)(16)(17). Second, the use of metformin is not recommended in patients with renal insufficiency.…”