Diabetes and heart failure are linked; treatment should be too
By American Heart Association News
Having Type 2 diabetes or heart failure independently increases the risk for getting the other, and both often occur together, further worsening a patient's health, quality of life and care costs, a new report says.
Many of the risk factors and mechanisms behind Type 2 diabetes and heart failure are similar, yet there's a lack of guidance on how to care for people with both conditions, according to a scientific statement from the American Heart Association and the Heart Failure Society of America published Thursday in the journal Circulation.
Recent studies have found new treatments for diabetes may also improve heart failure outcomes, showing the interplay between the two conditions, the report says.
The statement summarizes what's known about the inner workings of diabetes and heart failure and the best ways to treat the conditions when they occur simultaneously.
But it also encourages clinicians to coordinate the care and treatment of patients who have both conditions in "a thoughtful and cohesive way," said Dr. Shannon Dunlay, who co-chaired the report's writing committee.
It's not uncommon for a patient to see a cardiologist for heart failure and then visit a primary care doctor or endocrinologist for help managing diabetes, she said. But physicians need to be aware of how medications used for one condition affect the outcome of another.
"There's so much new data coming out all the time. We want to bring attention to the fact that diabetes and heart failure have substantial overlap, and it's important to stay up to date on new information," said Dunlay, a heart failure cardiologist at the Mayo Clinic in Rochester, Minnesota.
Ideally, all the patient's care teams would be aligned.
"It's easy to focus on the main problem you are treating, such as heart failure. But it's important to think about other medical conditions patients have when prescribing new therapies," she said.
People who have Type 2 diabetes, characterized by elevated blood sugar levels, are two to four times more likely to develop heart failure than someone without diabetes. But heart failure, a condition in which the heart fails to efficiently pump oxygenated blood through the body, also is a risk factor for diabetes.
Both disorders are characterized by insulin resistance and high levels of inflammation, said Dr. Rozalina McCoy, another member of the statement's writing committee.
"People who have both these conditions have a much higher risk of worse health outcomes – more hospitalizations, more emergency department visits, earlier death, and worse health overall than people who have just one of these conditions," said McCoy, an endocrinologist and internal medicine physician at Mayo Clinic.
Since people who have either condition are at increased risk for developing the other, they should take proactive steps to improve their health, she said.
It's important to get regular exercise, maintain a healthy weight and eat a well-balanced diet. People with diabetes also need to keep their blood sugar levels under control. The statement describes in detail a new class of medications called SGLT-2 inhibitors that lower blood sugar in adults with diabetes. But research shows these drugs also are effective in reducing the risk of developing heart failure and helping manage the condition in those who already have it, preventing heart failure-related hospitalizations and deaths.
It's important that people with either or both conditions touch base regularly with their doctors, Dunlay said.
"There's still a lot that we don't know about how best to manage patients with diabetes and heart failure, but a number of ongoing studies will help to elucidate things further," she said. "This is an exciting area in medicine and science right now, and we're going to find a lot of opportunities to improve patient management and outcomes."
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