Heart failure is a major cause of morbidity and mortality from cardiovascular disease. Recent studies have shown that rates of incident heart failure hospitalization (adjusted for age and sex) were twice as high in individuals with diabetes compared with individuals without diabetes. Individuals with diabetes may have heart failure with preserved ejection fraction (HFpEF) or with reduced ejection fraction (HFrEF), which is often preceded by hypertension. ASCVD can coexist with heart failure, and myocardial infarction occurs frequently in patients with HFrEF.
For glycemic management in patients with heart failure, ADA recommends that:
In patients with type 2 diabetes and established 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 > 30 mL/min/1.73 m2; however, metformin should be avoided in unstable or hospitalized patients with heart failure.
Editor's note: Skill Checkups are wholly fictional or fictionalized clinical scenarios intended to provide evidence-based educational takeaways.
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Cite this: Anne L. Peters. Skill Checkup: A 53-Year-Old Woman Recently Diagnosed With Type 2 Diabetes - Medscape - Dec 21, 2022.
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