Glucose and Insulin Abnormalities in Patients with Heart Failure

Abstract

The proportion of patients with heart failure (HF) who have diabetes is increasing. Patients with HF not known to be diabetic are at high risk of developing insulin resistance and impaired glucose tolerance, although the true prevalence and incidence are unknown. Despite the frequent co-occurrence of these conditions we have little evidence to direct prevention, screening and management of these patients, although earlier identification is advocated. This clinical update will define abnormal glucose levels and insulin resistance, review the pathophysiology, prevalence and incidence of glucose and insulin abnormalities in patients with HF, discuss prognostic implications, and make recommendations for clinical practice.

An assessment of the UK inpatient care for heart failure patients with diabetes

“…We found that patients with both heart failure and diabetes were significantly more likely to attend A&E and to be readmitted to hospital as an emergency due to the exacerbation of heart failure than those patients with heart failure but without diabetes, which is consistent with findings from previous studies. 11,12 Despite consistent evidence that optimization of diabetes management reduces long term cardiovascular complications and improves outcomes, 15,16 nonetheless we found that diabetes management (such as diabetes medication adjustment, review by the DSNs) during admission was not prioritized, that HbA1c was infrequently measured as a method of assessing glycaemic control, and referring to diabetes services at discharge was rare. Thus the opportunities for most patients to optimize their diabetes treatment were missed during their heart failure admission.…”

“…10 The prevalence of diabetes in the general adult population is 8.5%, 11 and in patients with heart failure is 30–47%. 12 The presence of diabetes in patients with heart failure is independently associated with poorer cardiac functional status and poorer outcomes, including greater morbidity and mortality, as well as increased risk of hospitalization. 13,14…”

“…population is 8.5%, 11 and in patients with heart failure is 30-47%. 12 The presence of diabetes in patients with heart failure is independently associated with poorer cardiac functional status and poorer outcomes, including greater morbidity and mortality, as well as increased risk of hospitalization. 13,14 Optimization of diabetes management reduces long term cardiovascular complications and improves outcomes, 15,16 but when patients with diabetes are admitted for other reasons there may be lost opportunities in managing diabetes and optimizing outcomes; whether this has occurred in patients with heart failure and diabetes remains unknown.…”

An implementation science study to enhance cardiovascular disease prevention in Mukono and Buikwe districts in Uganda: a stepped-wedge design

“…Globally, approximately one third of all deaths are attributed to cardiovascular disease (CVD) [1]. In Europe, CVD are estimated to be responsible for half of all deaths causing more deaths than any other condition [2].…”

Dietary intake of n-3 long-chain polyunsaturated fatty acids and risk of myocardial infarction in coronary artery disease patients with or without diabetes mellitus: a prospective cohort study

“…Randomized trials with n-3 LCPUFA intervention have shown reduced mortality [7] and improved left ventricular systolic function and functional capacity [8,9] among patients with heart failure, who are frequently insulin resistant [10]. In general, patients with diabetes mellitus are at increased risk of cardiovascular disease complications, including acute myocardial infarction (AMI) and mortality, as compared to patients without diabetes [11].…”