Heart Failure in Diabetes mellitus: Clinical Features and Prognostic Implications

Abstract

We defined the prevalence and impact on survival of clinical bedside variables in 385 patients with symptomatic congestive heart failure (CHF), of whom there were 176 with and 209 without diabetes mellitus. Patients were consecutively hospitalized and admitted for various acute conditions. Following discharge all-cause mortality was recorded. Prevalence and association of various variables with mortality were statistically analyzed. Prevailing in the diabetics versus nondiabetics were younger age (p < 0.05), pulmonary edema on admission (p = 0.002), using furosemide >80 mg/day (p < 0.01) for >1 year (p < 0.01) and hyponatremia (p = 0.01). Less prevalent were chronic lung disease (p < 0.01) and cardiac arrhythmias (p = 0.001). On follow-up extending up to 60 months, diabetic patients, especially those with fasting blood glucose levels on admission ≧180 mg/dl, survived for a shorter period of time than nondiabetics (p = 0.02). Associated with increased mortality in the diabetic group were female gender (p = 0.04), furosemide ≧80 mg/day (p < 0.001) and renal dysfunction (RD; p = 0.04). The respective variables in the nondiabetics were advanced age (p < 0.001) and RD (p = 0.002). Although they were younger, diabetic patients presented more severe CHF. It is recommended that special attention should be given to diabetic females, those using higher furosemide dosages and those suffering from RD.

The effect of glycaemic control and glycaemic variability on mortality in patients hospitalized with congestive heart failure

“…Previous studies have analyzed hospital glycemic control on the basis of admission [1,4,5] or mean morning [7,8] glucose. However, these may not adequately capture true glycemic exposure.…”

“…Several studies have shown that diabetes is an independent predictor of mortality in patients with CHF, but little is known about the relative importance of various metrics of glycemic control and CHF outcomes in the hospital [2,3]. Several investigators have shown that admission glucose in patients with CHF is independently associated with mortality [1,4,5], although this finding is not universal [6]. However, admission glucose does not provide a basis for intervention and more comprehensive assessments of glucose exposure may be useful for characterizing any association between mortality and glycemic control.…”

“…Previous studies have analyzed glycemic control using admission [1,4,5] (in CHF patients) or mean morning [7,8] (in the intensive care unit, ICU) glucose and different definitions of hypoglycemia. Of recent interest is the role of glycemic variability in outcomes.…”

A pilot test of an integrated self-care intervention for persons with heart failure and concomitant diabetes

“…Nearly one-third to one-half of people with HF have concomitant DM (Adams et al, 2005; Greenberg et al, 2007; Masoudi & Inzucchi, 2007; Sarma et al, 2013). There is a 40% to 80% increased risk of mortality among HF patients with DM, and a reported 1.6 fold increase in the relative risk for rehospitalization over those without DM (Bobbio et al, 2003; De Groote et al, 2004; Domanski et al, 2003; Dries, Sweitzer, Drazner, Stevenson, & Gersh, 2001; From et al, 2006; Gorelik et al, 2005). This is due to both worsening HF and higher burden of other co-morbidities, such as ischemic heart disease.…”