Type 2 Diabetes Mellitus and Heart Failure, A Scientific Statement From the American Heart Association and Heart Failure Society of America

Dunlay, Shannon M.; Givertz, Michael M.; Aguilar, David; Allen, Larry A.; Chan, Michael; Desai, Akshay S.; Deswal, Anita; Dickson, Victoria Vaughan; Kosiborod, Mikhail; Lekavich, Carolyn L.; McCoy, Rozalina G.; Mentz, Robert J; Piña, Ileana L.

doi:10.1016/j.cardfail.2019.05.007

Cited by 96 publications

(110 citation statements)

References 266 publications

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“…A similar trend of antidiabetic medication use over time, including TZDs, was observed in the general diabetes population. This suggests that despite different label contraindications/recommendations, there is insufficient guidance on the best treatment approach in patients with diabetes and HF, according to a scientific statement from the American Heart Association and the Heart Failure Society of America 13. Our findings update a prior analysis that found an increase in the use of metformin and TZDs 5.…”

mentioning

confidence: 68%

Twelve‐year trends in pharmacologic treatment of type 2 diabetes among patients with heart failure in the United States

Dawwas

Leonard

Garg

et al. 2020

Diabetes Obesity Metabolism

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We conducted a cross‐sectional analysis using a database from commercial health plans in the United States to describe trends in the use of antidiabetic medications among patients with type 2 diabetes and heart failure (HF) from 2006 through 2017. We used loop diuretic dose as a surrogate for HF severity (mild HF 0‐40 mg/day, moderate‐severe HF >40 mg/day). We assessed antidiabetic medication dispensing in the 90 days following HF diagnosis. Over the 12‐year period, we identified an increase in the use of metformin (39.2% vs. 62.6%), dipeptidyl peptidase‐4 inhibitors (DPP‐4i) (0.5% vs. 17.1%) and sodium‐glucose co‐transporter‐2 inhibitors (SGLT‐2i) (0.0% vs. 9.0%), but a decrease in the use of sulphonylureas (47.8% vs. 27.8%) and thiazolidinediones (TZDs) (31.7% vs. 5.3%). In 2017, patients with moderate‐severe HF more commonly used insulin (43.1%); a majority of mild HF patients used metformin (62.8%). A proportion of patients with moderate‐severe HF used TZDs (4.4%). Among patients with diabetes and HF, the use of metformin and DPP‐4i rapidly increased, but a proportion of patients with moderate‐severe HF continued to use TZDs. Despite their promising cardiovascular safety profile, SGLT‐2i use remains limited.

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confidence: 68%

Twelve‐year trends in pharmacologic treatment of type 2 diabetes among patients with heart failure in the United States

Dawwas

Leonard

Garg

et al. 2020

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

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“…SGLT-2i represent a relatively new class of drugs for T2DM; they were approved in the USA and Europe in 2013. Their glucose-lowering effect occurs via an insulin-independent pathway mainly through glucosuria, increasing the urinary excretion of glucose and the fractional excretion of sodium, with modest diuretic and natriuretic effects [4]. It is expected that, with their use, HbA1c will be decreased by about 0.5-1% [23][24][25] (IFCC: 5.5-11 mmol/mol).…”

Section: Glucose-lowering Effects Of Sglt-2imentioning

confidence: 99%

“…Over the last years, 3 important clinical trials have been conducted regarding the cardiovascular safety and benefits of SGLT-2i [4]: the EMPA-REG OUTCOME trial (for 10 or 25 mg of empagliflozin) [26], the CANVAS Program (for 100 or 300 mg of canagliflozin) [27], and DECLARE-TIMI 58 (for 10 mg of dapagliflozin) [28], all performed on T2DM patients. Although these studies focused on different populations (as detailed in Table 1), which may account for the different findings, the combined data suggests that this new class reduces the risk of major adverse cardiovascular events (MACE) -a combined endpoint of death from cardiovascular causes, nonfatal myocardial infarction (MI), or nonfatal stroke -by 14% in patients with atherosclerotic cardiovascular disease, i.e., there were no differences statistically significant in patients with only multiple risk factors and no cardiovascular disease [29].…”

Section: Cardiovascular Effects Of Sglt-2i: Effects On Major Adverse mentioning

confidence: 99%

“…Moreover, they showed that sodiumglucose cotransporter-2 inhibitors (SGLT-2i) and some glucagon-like peptide-1 receptor agonists could significantly reduce the risk of cardiovascular events, changing the landscape of T2DM treatment. Instead of an exclu-Diabetic cardiomyopathy is defined as the presence of diastolic or systolic dysfunction in a patient with DM without other obvious causes of cardiomyopathy, such as coronary artery disease, hypertension, or valvular heart disease [4][5][6]. It is initially characterized by myocardial fibrosis and dysfunctional remodeling and associated diastolic dysfunction, followed by systolic dysfunction and, eventually, clinical HF [6].…”

Section: Introductionmentioning

confidence: 99%

“…Likewise, HF also acts as a risk factor for T2DM, as its incidence in HF studies is more than twice that in the general population [4]. The prevalence of HF in patients with T2DM is about 10-23%, i.e., 3 times higher than in nondiabetes control groups [14,15].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

SGLT-2 Inhibitors in Heart Failure and Type-2 Diabetes: Hitting Two Birds with One Stone?

2019

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Type 2 diabetes mellitus (T2DM) and heart failure (HF) have a tremendous impact worldwide, markedly reducing life-expectancy and quality of life. It is now known that each disease represents a risk factor for the other. Moreover, when they are combined, the prognosis is significantly worse. Until recently, these pathologies have been managed independently. However, their treatment paradigm is rapidly changing, with recent cardiovascular outcome trials showing that sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are effective in the management of both diseases. This article explores the interactions between T2DM and HF and the concept of diabetic cardiomyopathy and summarizes recent data regarding the effects of SGLT-2i on HF hospitalization and the proposed pathophysiological mechanisms involved. sively "glucocentric approach," T2DM management should rather contemplate the use of strategies that can reduce the risk of cardiovascular (and renal) events, including these new drugs and integrated control of all cardiovascular risk factors.This article aims to review the interaction between T2DM and HF and the concept of diabetic cardiomyopathy and to summarize recent data regarding the effects of SGLT-2i on HF hospitalization (HHF) and the proposed pathophysiological mechanisms involved.

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Type 2 diabetes and heart failure: insights from the global DISCOVER study

et al. 2021

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Aims Heart failure (HF) is increasingly recognized as a major cause of morbidity and mortality in patients with type 2 diabetes (T2D), but the global epidemiology and treatment of HF in T2D are not well defined. This study aimed to examine the global prevalence of HF and the incidence of HF over 3 years of follow-up in patients with T2D [by presence and absence of co-existing coronary artery disease (CAD)]. Methods and results DISCOVER was a 3 year, prospective, observational study of T2D patients enrolled at initiation of second-line glucose-lowering therapy. Among 14 057 patients with T2D from 36 countries, 289 (2.1%) had a diagnosis of HF at enrolment; median prevalence across countries was 2.0% (inter-quartile range 1.0-3.1%). Patients with HF at baseline were more likely to be older [HF vs. no HF: 67 ± 12 vs. 57 ± 12 years, standardized difference (StDiff) = 84%] and have longer duration of T2D (8.1 ± 7.2 vs. 5.6 ± 5.2 years, StDiff = 40%), CAD (44% vs. 6%, StDiff = 97%), atrial fibrillation (21% vs. 1%, StDiff = 66%), and kidney disease (23% vs. 4%, StDiff = 55%). Patients with HF were less likely to be on metformin (66% vs. 79%, StDiff = 28%) and thiazolidinediones (5.5% vs. 10.6%, StDiff = 19%) but had similar use of other glucose-lowering medications. Among 9313 patients with follow-up data, there were 70 incident cases of HF, which translates to an incidence of 2.6 cases per 1000 person years. Of these incident HF cases, 60% occurred in the absence of pre-existing or concomitant CAD, and 73% were diagnosed in the outpatient setting. Conclusions In a large, global cohort of patients with T2D, the majority of incident cases of HF occurred in outpatients and in the absence of known CAD. These findings highlight the need for greater awareness of HF risk in patients with T2D.

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Type 2 Diabetes Mellitus and Heart Failure, A Scientific Statement From the American Heart Association and Heart Failure Society of America

Cited by 96 publications

References 266 publications

Twelve‐year trends in pharmacologic treatment of type 2 diabetes among patients with heart failure in the United States

Twelve‐year trends in pharmacologic treatment of type 2 diabetes among patients with heart failure in the United States

SGLT-2 Inhibitors in Heart Failure and Type-2 Diabetes: Hitting Two Birds with One Stone?

Type 2 diabetes and heart failure: insights from the global DISCOVER study

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