A comprehensive review on diabetes mellitus and heart failure

Abstract

Diabetes affects approximately 463 million people worldwide, and this number is projected to reach 700 million by 2045. The most significant cause of increased mortality among diabetic patients is cardiovascular disease, with heart failure (HF) being one of the most commonly observed conditions within this group. Type 2 diabetes mellitus (T2DM), characterized by insulin resistance, accounts for more than 90% of all diabetes cases. Patients with T2DM have twice the risk of developing HF compared to non-diabetic individuals. The connection between diabetes mellitus (DM) and HF extends beyond the complications of ischemic heart disease, encompassing metabolic disturbances such as glucose toxicity and lipotoxicity resulting from insulin resistance, as well as vascular endothelial dysfunction, microcirculatory abnormalities, and capillary insufficiency. Lifestyle modifications for individuals with T2DM involve engaging in regular physical activity, maintaining a balanced diet, quitting smoking, and reducing alcohol consumption. For patients with reduced ejection fraction HF [heart failure with reduced ejection fraction (HFrEF)] and T2DM, guideline-recommended medical therapies [including ARNI, angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), beta-blockers, mineralocorticoid receptor antagonists (MRAs), and sodium glucose co-transporter-2 (SGLT2) inhibitors] should be considered. Recent large randomized controlled trials have demonstrated that SGLT2 inhibitors improve cardiovascular outcomes, including all-cause mortality, independent of diabetes status. This review will focus on the epidemiology, pathophysiology, risk factors for HF development, and treatment approaches in diabetic patients, particularly those with T2DM and systolic HF.

Keywords

Heart failure / diabetes mellitus / mortality / insulin resistance

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