Fast Five Quiz: Type 2 Diabetes and Heart Failure

Romesh Khardori, MD, PhD; Yasmine S. Ali, MD

Disclosures

February 15, 2022

The 2022 ADA Standards of Medical Care in Diabetes recommends the following for glycemic management in patients with heart failure:

  • In patients with type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD), multiple ASCVD risk factors, or diabetic kidney disease, a SGLT2 inhibitor with demonstrated cardiovascular benefit is recommended to reduce the risk for major adverse cardiovascular events and/or heart failure hospitalization

  • In patients with type 2 diabetes and established ASCVD or multiple risk factors for ASCVD, a GLP-1 RA with demonstrated cardiovascular benefit is recommended to reduce the risk for major adverse cardiovascular events

  • In patients with type 2 diabetes and established ASCVD or multiple risk factors for ASCVD, combined therapy with a SGLT2 inhibitor with demonstrated cardiovascular benefit and a GLP-1 RA with demonstrated cardiovascular benefit may be considered for additive reduction in the risk for adverse cardiovascular and kidney events

  • In patients with type 2 diabetes and established HFrEF, a SGLT2 inhibitor with proven benefit in this patient population is recommended to decrease risk of worsening heart failure and for cardiovascular death

  • In patients with type 2 diabetes with stable heart failure, metformin may be continued for glucose lowering if estimated glomerular filtration rate remains greater than 30 mL/min/1.73 m2; however, metformin should be avoided in unstable or hospitalized patients with heart failure

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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