Consensus document: management of heart failure in type 2 diabetes mellitus

Kaul, Upendra; Ray, Saumitra; Prabhakar, D; Kochar, Arun; Sharma, Kamal; Hazra, Prakash; Solanki, Dharmesh; Dutta, Anjan; Kumar, Viveka; Rao, M. Srinivasa; Oomman, Abraham; Dani, Sameer; Pinto, Brian; Raghu, T.R.

doi:10.1007/s10741-020-09955-7

Cited by 3 publications

(3 citation statements)

References 137 publications

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“…The etiology of heart failure includes both micro-and macrovascular pathologies along with nerves and myocardium lesions, of which lots of risk factors contributing to its development and progression (82,83). The complicated etiology and comorbidities make the treatment of heart failure a tough problem (80,81). In T2D patients, the excessive risk of heart failure along with the elusive mechanisms of antihyperglycemic drugs on the cardiovascular system have brought more difficulties to the management of heart failure (6).…”

Section: Discussionmentioning

confidence: 99%

“…SGLT-2is or SGLT-2/1is is the first class of diabetes drugs to display a benefit for HFO, and all three SGLT-2is or SGLT-2/1is with CVOTs reduced the risk of HHF among patients with T2D regardless of their prior history of HF (P<0.001, Figure 3) (19,20,77,78). Based on the strong evidence in the RCTs, SGLT-2is or SGLT-2/1is have been given a leading role in the treatment of HF in patients with T2D, and been recommended by significant guidelines (79)(80)(81). In the Standards of Medical Care in Diabetes-2020 released by the American Diabetes Association, SGLT-2is with an HF benefit have been recommended as add-on therapies for metformin in patients with T2D and HF, especially those with EF<45% (79).…”

Section: Sglt-2is or Sglt-2/1ismentioning

confidence: 99%

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The Effects of DPP-4 Inhibitors, GLP-1RAs, and SGLT-2/1 Inhibitors on Heart Failure Outcomes in Diabetic Patients With and Without Heart Failure History: Insights From CVOTs and Drug Mechanism

Pan

et al. 2020

Front. Endocrinol.

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Patients with type 2 diabetes (T2D) have a higher risk of heart failure (HF) than healthy people, and the prognosis of patients with diabetes and current or previous HF is worse than that of patients with only diabetes. We reviewed the HF outcomes in recently published cardiovascular outcome trials (CVOTs) of three new classes of anti-diabetic agents, namely, dipeptidyl peptidase-4 inhibitors (DPP-4is), glucagon-like-peptide 1 receptor agonists (GLP-1RAs), and sodium glucose cotransporter-2 inhibitors (SGLT-2is) or SGLT-2 and SGLT-1 dual inhibitors and divided the patients into two groups based on the history of HF (with or without) and analyzed their risks of HHF based on the receipt of the aforementioned anti-diabetes drug types. Since the follow-up period differed among the trials, we expressed the rate of HHF as events/1,000 person-years to describe the HF outcome. At last we pooled the data and analyzed their different effects and mechanisms on heart failure outcomes. Although DPP-4is did not increase the risk of HHF in T2D patients with a history of HF, they were associated with a significantly higher risk of HHF among patients without history of HF. Some GLP-1RAs reduced the risk of macrovascular events, but none of these drugs reduced the risk of HHF in patients with T2D irrespective of their HF history. It was not clarified whether SGLT-1/2is can improve the prognosis of macrovascular events in patients with T2D, but these drugs reduced the risk of HHF regardless of patients’ histories of HF. This information may be useful or referential for the “precise” selection of hyperglycemic medications. Further researches still needed to clarify the mechanisms of these anti-diabetic medications.

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Section: Discussionmentioning

confidence: 99%

Section: Sglt-2is or Sglt-2/1ismentioning

confidence: 99%

The Effects of DPP-4 Inhibitors, GLP-1RAs, and SGLT-2/1 Inhibitors on Heart Failure Outcomes in Diabetic Patients With and Without Heart Failure History: Insights From CVOTs and Drug Mechanism

Pan

et al. 2020

Front. Endocrinol.

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“…We have not examined the effects long-term levels of risk factors or use of medications, and one additional limitation of the study is the inclusion period, as treatment recommendations in early T2D and pharmaceutical options have changed considerably during the last 10 years, especially with regards to cardiovascular and renal conditions. The recommendations for treatment concomitant heart failure and T2D have also recently been updated 23 . Not only have several new drugs been introduced, but the recommendations even regarding metformin use and kidney function have changed, allowing metformin to be used even at lower eGFR 24 .…”

Section: Stratified By Age At Diagnosis (Years)mentioning

confidence: 99%

Risk trajectories of complications in over one thousand newly diagnosed individuals with type 2 diabetes

Höskuldsdóttir

Franzén

Eeg‐Olofsson

et al. 2022

Sci Rep

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Although the increased risk of complications of type 2 diabetes (T2D) is well known, there is still little information about the long-term development of comorbidities in relation to risk factors. The purpose of the present study was to describe the risk trajectories of T2D complications over time in an observational cohort of newly diagnosed T2D patients, as well as to evaluate the effect of common risk factors on the development of comorbidities. This national cohort study investigated individuals with T2D in the Swedish National Diabetes Register regarding prevalence of comorbidities at the time of diagnosis, and the incidence of cardiovascular disease (CVD), chronic kidney disease (CKD) and heart failure in the entire patient cohort and stratified by HbA1c levels and age at baseline. Multivariable Cox regressions were used to evaluate risk factors predicting outcomes. We included 100,878 individuals newly diagnosed with T2D between 1998 and 2012 in the study, with mean 5.5 years follow-up (max 17 years). The mean age at diagnosis was 62.6 ± SD12.5 years and 42.7% of the patients were women. Prevalent CVD was reported for 17.5% at baseline. Although the prevalence of comorbidities was generally low for individuals 50 years or younger at diagnosis, the cumulative incidence of the investigated comorbidities increased over time. Newly diagnosed CVD was the most common comorbidity. Women were shown to have a lower risk of developing comorbid conditions than men. When following the risk trajectory of comorbidities over a period of up to 15 years in individuals with type 2 diabetes, we found that all comorbidities gradually increased over time. There was no distinct time point when onset suddenly increased.

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Use of disease-modifying drugs in diabetic patients with heart failure with reduced ejection fraction

Masarone

Pacileo

2021

Heart Fail Rev

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Consensus document: management of heart failure in type 2 diabetes mellitus

Cited by 3 publications

References 137 publications

The Effects of DPP-4 Inhibitors, GLP-1RAs, and SGLT-2/1 Inhibitors on Heart Failure Outcomes in Diabetic Patients With and Without Heart Failure History: Insights From CVOTs and Drug Mechanism

The Effects of DPP-4 Inhibitors, GLP-1RAs, and SGLT-2/1 Inhibitors on Heart Failure Outcomes in Diabetic Patients With and Without Heart Failure History: Insights From CVOTs and Drug Mechanism

Risk trajectories of complications in over one thousand newly diagnosed individuals with type 2 diabetes

Use of disease-modifying drugs in diabetic patients with heart failure with reduced ejection fraction

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