Fast Five Quiz: Type 2 Diabetes and Heart Failure

Romesh Khardori, MD, PhD


July 15, 2021

Barring contraindications, metformin is still recommended as the first-line therapeutic agent in patients with type 2 diabetes, and it is appropriate to use metformin in patients with diabetes at risk of developing or with pre-existing heart failure. However, metformin use should be terminated in patients who have acute, lactic acidosis-related conditions, including cardiogenic or distributive shock.

When making treatment decisions about glucose-lowering therapy, physicians should also consider a patient's life expectancy because intensive glycemic control can take up to 10 years to show benefits.

Insulin is sometimes needed to achieve glycemic control for some patients with cooccurring diabetes and heart failure. However, it should be used with vigilance because it can result in weight gain and risk for hypoglycemia. If glucose levels can be controlled without insulin, other agents such as metformin and SGLT2 inhibitors are appropriate. The ORIGIN trial assessed the cardiovascular safety of insulin, and yielded no difference in cardiovascular outcomes.

Learn more about the treatment and management of diabetes.


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