The double burden: type 1 diabetes and heart failure—a comprehensive review

Abstract

Heart failure (HF) is increasing at an alarming rate, primary due to the rising in aging, obesity and diabetes. Notably, individuals with type 1 diabetes (T1D) face a significantly elevated risk of HF, leading to more hospitalizations and increased case fatality rates. Several risk factors contribute to HF in T1D, including poor glycemic control, female gender, smoking, hypertension, elevated BMI, and albuminuria. However, early and intensive glycemic control can mitigate the long-term risk of HF in individuals with T1D. The pathophysiology of diabetes-associated HF is complex and multifactorial, and the underlying mechanisms in T1D remain incompletely elucidated. In terms of treatment, much of the evidence comes from type 2 diabetes (T2D) populations, so applying it to T1D requires caution. Sodium-glucose cotransporter 2 inhibitors have shown benefits in HF outcomes, even in non-diabetic populations. However, most of the information about HF and the evidence from cardiovascular safety trials related to glucose lowering medications refer to T2D. Glycemic control is key, but the link between hypoglycemia and HF hospitalization risk requires further study. Glycemic variability, common in T1D, is an independent HF risk factor. Technological advances offer the potential to improve glycemic control, including glycemic variability, and may play a role in preventing HF. In summary, HF in T1D is a complex challenge with unique dimensions. This review focuses on HF in individuals with T1D, exploring its epidemiology, risk factors, pathophysiology, diagnosis and treatment, which is crucial for developing tailored prevention and management strategies for this population.

Epidemiología de las enfermedades cardiovasculares: una revisión narrativa

“…En muchos países incluyendo EE.UU., el tabaquismo ha disminuido dramáticamente, pasando de más del 40% de los adultos a mediados de la década de 1960 a ≈11% en la actualidad. Sin embargo, después de décadas de disminución en las tasas de ECV, las tendencias más recientes están aumentando, atribuidas en parte al empeoramiento de factores de riesgo como la diabetes, el envejecimiento de la población, las desigualdades en salud y otros factores (Julián et al, 2024). En un estudio llevado a cabo en cuatro países suramericanos (Colombia, Chile, Argentina y Brasil) se evidenció que las principales causas de muerte fueron ECV (31,1%), cáncer (30,6%) y enfermedades respiratorias (8,6%) y representan más de dos tercios de las muertes en Sudamérica.…”

“…Los patrones globales de ECV total tienen implicaciones importantes para la práctica clínica y el desarrollo de políticas de salud pública. Es probable que la prevalencia de ECV aumente sustancialmente como resultado del crecimiento y el envejecimiento de la población, la obesidad y la diabetes, especialmente en algunos países identificados incluyendo América Latina y el Caribe, donde la proporción de personas mayores se prevé que se duplique entre 2019 y 2050 (United Nations, 2020;Julián et al, 2024), por lo que es necesaria una mayor atención a la promoción de una salud cardiovascular ideal y un envejecimiento saludable en estas poblaciones e implementar estrategias viables y asequibles que además permitan monitorear o dar seguimiento a los resultados. Existen iniciativas, pero se conoce poco el impacto que han tenido hasta el momento y en especial en este grupo etario.…”

Harnessing the Synergy of SGLT2 Inhibitors and Continuous Ketone Monitoring (CKM) in Managing Heart Failure among Patients with Type 1 Diabetes

“…A cascade of potentially fatal events means that while T1D and T2D increase the risk of developing HF, in turn, HF also increases the risk of premature death in patients with T1D and T2D [4,7]. In registry studies, the prevalence of T2D among subjects with HF ranges from 25 to 40% [5,[8][9][10] while ranging between 30 and 50% in HF clinical trials [11][12][13][14][15][16]. Although most of these trials were conducted in subjects with T2D, even in T1D, which accounts for 10% of patients with diabetes [17], the risk of HF is three to five times higher than that in controls [4,18].…”