Diabetes duration: A risk factor for incident heart failure


Dr Sanjay Kalra, DM (AIIMS); President-elect, SAFES, Bharti Hospital, Karnal, India; and Dr Hitesh Punyani, Director, Chaitanya Cardio Diabetes Centre, New Delhi; Sr. Consultant Medicine, Apollo Cradle Hospital    06 February 2023

The risk of new onset of heart failure is increased by almost 50% among diabetic patients who have had the condition for more than 15 years, according to a study published in The Journal of Clinical Endocrinology and Metabolism.1


Data of 23,754 patients with type 1 or type 2 diabetes from the prospective UK Biobank study was studied to explore the correlation between the duration of diabetes and risk of new onset of heart failure. Their mean age was 61 years and 32.4% of them were women. A history of coronary heart disease was present in 17%. None of the participants had heart failure at the time of their enrollment. Glycosylated hemoglobin A1c (HbA1c) levels were used to determine glycemic control. Based on their self-reported duration of diabetes, all the study subjects were categorized into four groups: < 5 years, 5-9 years, 10-14 years and ≥ 15 years. 


Analysis of data revealed that the duration of diabetes as well as the glycemic status positive correlated with the risk of incident heart failure. Over a median follow-up of 11.7 years, 2081 people developed incident heart failure.


Among participants who had had longstanding diabetes for ≥ 15 years, the risk of incident heart failure increased by 32% with hazard ratio (HR) of 1.32 compared to those who had been diagnosed with diabetes within the preceding 5 years. The HR was 1.09 for participants whose duration of diabetes ranging from 5 years to less than 10 years and in participants who had had diabetes for 10-14 years, the HR was 1.13.


The association of glycemic status and heart failure also showed similar trends. Baseline A1c levels ≥8.0% were associated with 46% increase in the incidence of heart failure when compared with those with baseline A1c < 7.0% with HR of 1.46. The HR for development of heart failure for A1c levels ranging from 7.0% to < 7.5% was 1.15. For A1c levels 7.5% to < 8.0%, the HR was 1.07 and for A1c levels > 8.0.


Type 2 diabetes is recognized as a risk factor for incident heart failure. It has been described as “the second most common initial presentation of cardiovascular disease” in these patients.2 This study demonstrates the impact of the duration of diabetes on the risk of incident heart failure, which was greatest among patients who had the longest duration of diabetes, ≥15 years. Patients with poor glycemic control (≥8%) were similarly at higher risk of heart failure. Patients who had both a longer duration of diabetes plus poor glycemic status were at a significantly higher risk compared to patients with shorter duration of diabetes and good glycemic control. This association was independent of age, sex, and race”, noted the authors. Hence, clinicians managing patients with diabetes should keep in mind the duration of diabetes and carefully monitor them for signs of impending heart failure for early detection and timely intervention.




  1. Yang HH, et al. Duration of diabetes, glycemic control, and risk of heart failure among adults with diabetes: a cohort study. J Clin Endocrinol Metab. 2022 Nov 16;dgac642. doi: 10.1210/clinem/dgac642.
  2. Echouffo-Tcheugui J. Does the duration of diabetes matter when evaluating the risk of heart failure? J Clin Endocrinol Metab. 2022 Dec 31:dgac761. doi: 10.1210/clinem/dgac761.

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