medigraphic.com
Colegio de Medicina Interna de México.

2022, Number 5

<< Back Next >>

Med Int Mex 2022; 38 (5)

Type 2 diabetes mellitus in a heart failure clinic of a Latin American reference center

Palmezano-Díaz JM, Saldarriaga-Giraldo CI, Torres-Yepes V, Tobón-Upegui PM

Language: Spanish
References: 37
Page: 990-1000
PDF size: 226.34 Kb.


ABSTRACT

Objectivoe: To describe the characteristic and the prognosis of patients with heart failure and diabetes.
Materials and Methods:A retrospective cohort study was carried out in the population of patients with diabetes and heart failure from the reference center in Colombia, from 2012 to 2020.
Results: One thousand four hundred seventy-seven patients were analyzed, 299 (20,2%) were diabetic, 95 (6.4%) were prediabetic and 1083 (73.3%) were not diabetic. Of the patients with diabetes, 287 were analyzed, the average age was 70.2 years, 191 (66.6%) were men, 167 (58.2%) had ischemic heart disease, 264 (92%) arterial hypertension, 204 (71.1%) dyslipidemia, 178 (62%) overweight, 143 (49.8%) chronic kidney disease. For the treatment of heart failure, 207 (72%) patients received ACEI/ ARA II, 28 (9.8%) ARNI, 269 (93.7%) beta blockers, 183 (63.8%) antialdosterone, 214 (74.6%) diuretics. For the treatment of diabetes, 148 (51.6%) patients received insulin, 165 (57.4%) biguanides, 37 (12.9%) SGLT2, 47 (16.4%) IDDP4, 15 (5.2%) GLP1, 7 (2.4%) sulfonylureas. With respect to cardiac devices, 53 (18.5%) patients had CRT, 48 (16.7%) had a ICD, 24 (8.4%) had a pacemaker. For coronary intervention there were 51 (17.8%) surgical revascularization and 93 (32.4%) had percutaneous coronary intervention. The mortality was of 33 (11.5%) patients in the program of institutional heart failure.
Conclusions: In this group of patients with heart failure with diabetes, we found a high burden of comorbidities, low use of iSGLT2 and optimal pharmacological management against heart failure.


REFERENCES

  1. Lehrke M, Marx N. Diabetes mellitus and heart failure.Am J Cardiol 2017; 120 (1S): S37-47. doi: 10.1016/j.amjcard. 2017.05.014.

  2. Dei Cas A, Fonarow GC, Gheorghiade M, Butler J.Concomitant diabetes mellitus and heart failure. CurrProbl Cardiol 2015; 40 (1): 7-43. doi: 10.1016/j.cpcardiol.2014.09.002.

  3. Dei Cas A, Khan SS, Butler J, Mentz RJ, Bonow RO, AvogaroA, et al. Impact of diabetes on epidemiology, treatment,and outcomes of patients with heart failure. JACC HeartFail 2015; 3 (2): 136-45. doi: 10.1016/j.jchf.2014.08.004.

  4. Lombardi C, Spigoni V, Gorga E, Dei Cas A. Novel insightinto the dangerous connection between diabetes andheart failure. Herz 2016; 41 (3): 201-7. doi: 10.1007/s00059-016-4415-7.

  5. Langford MC. Type 2 diabetes and chronic systolic heartfailure: clinical implications. J Cardiovasc Nurs 2004; 19(6 Suppl): S35-44; quiz S45-46. doi: 10.1097/00005082-200411001-00005.

  6. Fonarow GC. An approach to heart failure and diabetes mellitus.Am J Cardiol 2005; 96 (4A): 47E-52E. doi: 10.1016/j.amjcard.2005.06.005.

  7. Masoudi FA, Inzucchi SE. Diabetes mellitus and heart failure:epidemiology, mechanisms, and pharmacotherapy.Am J Cardiol 2007; 99 (4A): 113B-132B. doi: 10.1016/j.amjcard.2006.11.013.

  8. Risk related to pre-diabetes mellitus and diabetes mellitusin heart failure with reduced ejection fraction: insights fromprospective comparison of ARNI with ACEI to determineimpact on global mortality and morbidity in heart failuretrial - PubMed [Internet]. [citado 8 de abril de 2021].Disponible en: https://pubmed-ncbi-nlm-nih-gov.consultaremota.upb.edu.co:8443/26754626/. doi: 10.1161/CIRCHEARTFAILURE.115.002560.

  9. Trang A, Aguilar D. Treating disease mechanisms in patientswith heart failure and diabetes mellitus. Curr Heart Fail Rep2017; 14 (6): 445-53. doi: 10.1007/s11897-017-0371-7.

  10. Schütt K, Marx N. Diabetes and heart failure: Update 2017.Herz 2017; 42 (3): 329-40. doi: 10.1007/s00059-017-4558-1.

  11. Thomas MC. Type 2 diabetes and heart failure: challengesand solutions. Curr Cardiol Rev 2016; 12 (3): 249-55. doi:10.2174/1573403x12666160606120254.

  12. Insulin signaling and heart failure - PubMed [Internet].[citado 8 de abril de 2021]. Disponible en: https://pubmed-ncbi-nlm-nih-gov.consultaremota.upb.edu.co:8443/27034277/

  13. Sandesara PB, O’Neal WT, Kelli HM, Samman-Tahhan A,Hammadah M, Quyyumi AA, et al. The prognostic significanceof diabetes and microvascular complications inpatients with heart failure with preserved ejection fraction.Diabetes Care 2018; 41 (1): 150-5. doi: 10.2337/dc17-0755.

  14. Low Wang CC, Hess CN, Hiatt WR, Goldfine AB. ClinicalUpdate: Cardiovascular disease in diabetes mellitus: atheroscleroticcardiovascular disease and heart failure in type 2diabetes mellitus - mechanisms, management, and clinicalconsiderations. Circulation 2016; 133 (24): 2459-502. doi:10.1161/CIRCULATIONAHA.116.022194.

  15. Blecker S, Park H, Katz SD. Association of HbA1c withhospitalization and mortality among patients with heartfailure and diabetes. BMC Cardiovasc Disord 2016; 16: 99.doi: 10.1186/s12872-016-0275-6.

  16. Heart failure prevalence, incidence, and mortality in theelderly with diabetes - PubMed [Internet]. [citado 8 de abrilde 2021]. Disponible en: https://pubmed-ncbi-nlm-nih-gov.consultaremota.upb.edu.co:8443/14988288/

  17. Effect of liraglutide, a glucagon-like peptide-1 analogue,on left ventricular function in stable chronic heart failurepatients with and without diabetes (LIVE)-a multicentre,double-blind, randomised, placebo-controlled trial - Pub-Med [Internet]. [citado 8 de abril de 2021]. Disponible en:https://pubmed-ncbi-nlm-nih-gov.consultaremota.upb.edu.co:8443/27790809/

  18. Rationale and design of a randomized trial to test thesafety and non-inferiority of canagliflozin in patients withdiabetes with chronic heart failure: the CANDLE trial - Pub-Med [Internet]. [citado 8 de abril de 2021]. Disponible en:https://pubmed-ncbi-nlm-nih-gov.consultaremota.upb.edu.co:8443/27044332/

  19. von Haehling S, Hasenfuß G, Anker SD. Diabetes and heartfailure: sugared words prove bitter. J Am Coll Cardiol 2016;68 (13): 1417-9. doi: 10.1016/j.jacc.2016.07.728.

  20. Mwita JC, Magafu MGMD, Omech B, Tsima B, Dewhurst MJ,Goepamang M, et al. Undiagnosed and diagnosed diabetesmellitus among hospitalised acute heart failure patients inBotswana. SAGE Open Med 2017; 5: 2050312117731473.doi: 10.1177/2050312117731473.

  21. Johansson I, Dahlström U, Edner M, Näsman P, RydénL, Norhammar A. Risk factors, treatment and prognosisin men and women with heart failure with and withoutdiabetes. Heart Br Card Soc 2015; 101 (14): 1139-48. doi:10.1136/heartjnl-2014-307131.

  22. Fonarow GC. Diabetes medications and heart failure: recognizingthe risk. Circulation 2014; 130 (18): 1565-7. doi:10.1161/CIRCULATIONAHA.114.012883.

  23. Sharma DC, Asirvatham A, Singh P. Dose modification ofantidiabetic agents in patients with type 2 diabetes mellitusand heart failure. Indian J Endocrinol Metab 2017; 21 (4):618-29. doi: 10.4103/ijem.IJEM_442_16.

  24. MacDonald MR, Petrie MC, Varyani F, Ostergren J, MichelsonEL, Young JB, et al. Impact of diabetes on outcomesin patients with low and preserved ejection fraction heartfailure: an analysis of the Candesartan in heart failure:assessment of reduction in mortality and morbidity(CHARM) programme. Eur Heart J 2008; 29 (11): 1377-85.doi: 10.1093/eurheartj/ehn153.

  25. Dhingra R, Vasan RS. Diabetes and the risk of heart failure.Heart Fail Clin 2012; 8 (1): 125-33. doi: 10.1016/j.hfc.2011.08.008.

  26. Stubnova V, Os I, Grundtvig M, Waldum-Grevbo B. Prevalentdiabetes mellitus: mortality and management innorwegian heart failure outpatients. Cardiology 2016; 134(4): 413-22. doi: 10.1159/000444658.

  27. Management of comorbid diabetes mellitus and worseningheart failure - PubMed [Internet]. [citado 8 de abril de2021]. Disponible en: https://pubmed-ncbi-nlm-nih-gov.consultaremota.upb.edu.co:8443/24938559/

  28. Tarantini L, Di Lenarda A, Velussi M, Faggiano P, ComaschiM, Faglia E, Maggioni AP. Diabetes mellitus, left ventriculardysfunction and congestive heart failure. Ital Heart J 2004;5 (8): 605-15.

  29. 2019 ESC Guidelines on diabetes, pre-diabetes, andcardiovascular diseases developed in collaboration withthe EASD: The Task Force for diabetes, pre-diabetes, andcardiovascular diseases of the European Society of Cardiology(ESC) and the European Association for the Study ofDiabetes (EASD). Rev Esp Cardiol Engl 2020; 73 (5): 404.doi: 10.1093/eurheartj/ehz486.

  30. Eplerenone, a selective aldosterone blocker, in patientswith left ventricular dysfunction after myocardial infarction- PubMed [Internet]. [citado 8 de abril de 2021]. Disponibleen: https://pubmed-ncbi-nlm-nih-gov.consultaremota.upb.edu.co:8443/12668699/

  31. Velazquez EJ, Morrow DA, DeVore AD, Ambrosy AP, Duffy CI,McCague K, et al. Rationale and design of the comParIsonOf sacubitril/valsartaN versus Enalapril on Effect on ntpRo-bnp in patients stabilized from an acute heart failureepisode (PIONEER-HF) trial. Am Heart J 2018; 198: 145-51.doi: 10.1016/j.ahj.2018.01.004.

  32. Kramer CK, Ye C, Campbell S, Retnakaran R. Comparison ofnew glucose-lowering drugs on risk of heart failure in type2 diabetes: a network meta-analysis. JACC Heart Fail 2018;6 (10): 823-30. doi: 10.1016/j.jchf.2018.05.021.

  33. Nasir S, Aguilar D. Congestive heart failure and diabetesmellitus: balancing glycemic control with heart failureimprovement. Am J Cardiol 2012; 110 (9 Suppl): 50B-57B.doi: 10.1016/j.amjcard.2012.08.031.

  34. Bahtiyar G, Gutterman D, Lebovitz H. Heart failure: a majorcardiovascular complication of diabetes mellitus. Curr DiabRep 2016; 16 (11): 116. doi: 10.1007/s11892-016-0809-4.

  35. O’Brien MJ, Karam SL, Wallia A, Kang RH, Cooper AJ, LanckiN, et al. Association of second-line antidiabetic medicationswith cardiovascular events among insured adults with type2 diabetes. JAMA Netw Open 2018; 1 (8): e186125. doi:10.1001/jamanetworkopen.2018.6125.

  36. Butler J, Januzzi JL, Rosenstock J. Management of heartfailure and type 2 diabetes mellitus: Maximizing complementarydrug therapy. Diabetes Obes Metab 2020; 22 (8):1243-62. doi: 10.1111/dom.14042.

  37. Blecker S, Park H, Katz SD. Association of HbA1c withhospitalization and mortality among patients with heartfailure and diabetes. BMC Cardiovas Disord 2016; 16: 99.doi: 10.1186/s12872-016-0275-6.




2020     |     www.medigraphic.com