First joint position paper on heart failure and diabetes published
11.08.2022 10:19
Studies show that almost a third of all diabetes patients have heart failure. There is also a highly estimated number of unreported cases. Conversely, heart failure is associated with poor metabolism: in relevant studies, 30 to 40 percent of all heart patients already have prediabetes or manifest type 2 diabetes. In order to draw greater attention to the frequency and sometimes fatal interaction of these diseases, The German Diabetes Society (DDG) and the German Society for Cardiology (DGK) have published their first joint position paper. This is intended to sensitize doctors to the clinical pictures and to draw attention to the need to subject those affected by both diseases to regular examinations and to provide interdisciplinary therapy.
“Diabetes mellitus and heart failure enter into a frequent, often underestimated and sometimes fatal interplay,” says Professor Dr. med. Thomas Forst, 1st chairman of the “Diabetes & Heart” working group of the DDG. Mortality from cardiovascular events is increased by 50 to 90 percent. “It is all the more important to identify these high-risk patients at an early stage and to improve their life expectancy through differentiated therapy,” says the internist. The first joint position paper from the two specialist societies DDG and DGK summarizes the current scientific data on both diseases in a compact manner. There are also recommendations for treating diabetologists and cardiologists on what should be taken into account during diagnosis and therapy.
Patients with diabetes mellitus are up to five times more likely to suffer from heart failure than metabolically healthy people - even at a younger age. In addition, so-called diastolic heart failure (HFpEF) is usually clinically inconspicuous. “It can therefore be assumed that the diagnosis of this form of heart failure is made far too rarely in people with diabetes and that there is a high number of unreported cases of those already affected,” explains the first author of the position paper, associate professor Dr. med. Katharina Schütt, spokeswoman for the DGK “Heart and Diabetes” working group. “If the person affected is symptomatic, such a dysfunction can be determined using echocardiography.” Accordingly, the position paper recommends regularly asking diabetes patients about the symptoms of heart failure. Conversely, heart failure patients have a significantly increased risk of developing type 2 diabetes mellitus. “Here, too, we strongly recommend regular diabetes screenings, in which the glucose and HbA1c values are measured and, if necessary, the OGTT is determined,” Professor Dr. med. Dirk Müller-Wieland, spokesman for the interdisciplinary DDG committee “Heart, Diabetes & Hormones of the DDG, DGE & DGK”.
The close connection between heart failure and diabetes can be explained by an overall metabolic disorder including the deterioration of the arterial and coronary condition. A persistently high long-term blood sugar level (HbA1c) increases chronic inflammatory processes in the vessels. Although the heart still pumps normally, the vessel walls become stiff and the heart no longer fills with enough blood, which triggers heart failure. Conversely, heart failure initiates diabetic processes that increase glucose metabolism and cause insulin resistance. “In the case of heart failure, one in five people affected does not survive twelve months after the first hospitalization. If it is recognized too late or underestimated, it is often fatal,” says cardiologist Schütt.
In addition to diagnostic recommendations, the position paper also provides therapy advice. In the case of heart failure, SGLT-2 inhibitors are currently the preferred antidiabetic strategy. They more often prevent adverse cardiovascular events and associated hospitalizations and thus also reduce the risk of death. At the same time, they protect against kidney damage, which also often occurs in these patients. “In order to break the vicious circle between diabetes and heart failure, it is particularly important to keep the metabolism stable at an HbA1c value of 7 percent,” says Forst.
The new position paper is aimed at specialists in diabetology and cardiology and is now available to those interested here: https://www.ddg.info/politik/stellungnahmen/positionspapier-herzinsuffizienz-und-diabetes
Sources:
Position paper from the DDG and DGK “Heart failure and diabetes”
Thieme E-Journals – Cardiology up2date / full text (thieme-connect.de)
German Health Report Diabetes 2022