Diabetes mellitus and heart failure (HF) commonly coexist, and together these conditions are associated with increased morbidity and mortality compared with either condition alone. Although the optimal treatment strategy to achieve glucose control in HF patients with type 2 diabetes has not been well studied, given the common coexistence of these conditions and the need to adequately treat hyperglycemia to prevent microvascular complications, it is important for clinicians to understand the potential implications of diabetic therapy in patients with established HF. Until recently, metformin was contraindicated in patients with HF because of the potential risk of lactic acidosis; however, recent retrospective studies of metformin use in HF patients have shown that this medication may be used safely and indeed may be beneficial in patients with stable HF. The association between thiazolidinediones (TZDs) and HF remains controversial, but recent prospective randomized trials of TZD use in HF patients suggest that worsening volume retention associated with these agents may lead to worsening of HF symptoms. The recently developed incretin-based therapies, such as exenatide and sitagliptin, also have not been extensively studied in HF populations; however, small pilot studies of glucagon-like peptide-1 have shown potential promise in the treatment of diabetic patients with HF. Although they may be difficult to perform, future randomized controlled trials are needed to establish optimal treatment goals and strategies in this population.
|Number of pages||11|
|Journal||Current Treatment Options in Cardiovascular Medicine|
|State||Published - 2008|
Bibliographical noteFunding Information:
Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation 2005, 112:e154–e235. Mokdad AH, Ford ES, Bowman BA, et al.: Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003, 289:76–79. Centers for Disease Control and Prevention: National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2005. Available at http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2005.pdf. Accessed June 2008. Diabetes mellitus: a major risk factor for cardiovascular disease. A joint editorial statement by the American Diabetes Association; the National Heart, Lung, and Blood Institute; the Juvenile Diabetes Foundation International; the National Institute of Diabetes and Digestive and Kidney Diseases; and the American Heart Association. Circulation 1999, 100:1132–1133. Kannel WB, McGee DL: Diabetes and cardiovascular disease. The Framingham study. JAMA 1979, 241:2035–2038. Nichols GA, Gullion CM, Koro CE, et al.: The incidence of congestive heart failure in type 2 diabetes: an update. Diabetes Care 2004, 27:1879–1884. Kostis JB, Sanders M: The association of heart failure with insulin resistance and the development of type 2 diabetes. Am J Hypertens 2005, 18:731–737.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine