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Etiopathogenesis and Management of Diabetic Heart Failure

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Dr Dheeraj Kapoor    24 November 2018

  1. Heart failure (HF) in patients with diabetes is still under-recognized and misdiagnosed. Untreated or undertreated HF has very poor prognosis.
  2. HF occurs at an earlier age in patients with diabetes; incidence is also 1-4 times higher vs. those with no diabetes.
  3. Diabetic HF can be independent of ischemic heart disease by way of diabetic cardiomyopathy that may manifest as normal or reduced LVEF.
  4. Treatment of T2DM in HF: Metformin (first-line), SUs and insulin (second-and third-line); TZDs (contraindicated); GLP-1 receptor agonists/DPP-4Is (do not reduce risk for HF hospitalization); SGLT2i (empagliflozin and canagliflozin significantly reduce HF hospitalization in at risk patients or those with established CVD).
  5. Presence of diabetes should not affect the decision for HF treatment.
  6. Comorbidities like renal dysfunction are more common in diabetes; people with diabetes are also more prone to hyperkalemia. These may influence doses of drugs used in HF and monitoring of therapy, but not therapeutic targets.

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