Canadian Journal of Cardiology

How Diabetes and Heart Failure Modulate Each Other and Condition Management

  • Varinder Kaur Randhawa
    Cardiovascular Medicine, Kaufman Center for Heart Failure, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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  • Savita Dhanvantari
    Metabolism and Diabetes, Imaging Program, Lawson Health Research Institute and Medical Biophysics, Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
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  • Kim A. Connelly
    Corresponding author: Dr Kim A. Connelly, Division of Cardiology, Department of Medicine, St Michael’s Hospital, 30 Bond Street, 7-052, Toronto, Ontario M5B 1W8, Canada. Tel.: +1-416-864-5201, ext. 5425; fax: +1-416-864-5571.
    Division of Cardiology, Department of Medicine, St Michael's Hospital, Keenan Research Centre for Biomedical Research, Toronto, Ontario, Canada
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Published:December 01, 2020DOI:


      Heart failure (HF) and diabetes mellitus (DM) confer considerable burden on the health care system. Although these often occur together, DM can increase risk of HF, whereas HF can accelerate complications of DM. HF is a clinical syndrome resulting from systolic or diastolic impairment caused by ischemic, nonischemic (eg, DM), or other etiologies. HF exists along a spectrum from stage A (ie, persons at risk of DM) to stage D (ie, refractory HF from end-stage DM cardiomyopathy [DMCM]). HF is further categorized by reduced, midrange, and preserved ejection fraction (EF). In type 2 DM, the most prevalent form of DM, several pathophysiological mechanisms (eg, insulin resistance and hyperglycemia) can contribute to myocardial damage, leading to DMCM. Management of HF and DM and patient outcomes are guided by EF and drug efficacy. In this review, we focus on the interplay between HF and DM on disease pathophysiology, management, and patient outcomes. Specifically, we highlight the role of novel antihyperglycemic (eg, sodium glucose cotransporter 2 inhibitors) and HF therapies (eg, renin-angiotensin-aldosterone system inhibitors) on HF outcomes in patients with DM and HF.


      L'insuffisance cardiaque (IC) et le diabète représentent un fardeau considérable pour le système de soins de santé. Même si ces deux affections sont souvent observées conjointement, le diabète peut accroître le risque d'IC, tandis que l'IC peut accélérer les complications du diabète. L'IC est un syndrome clinique qui est le résultat d'une dysfonction systolique ou diastolique d'origine ischémique, non ischémique (p. ex. diabète) ou autre. Le spectre de l'IC va du stade A (c.-à-d., personnes à risque de diabète) au stade D (c.-à-d., IC réfractaire attribuable à une cardiomyopathie diabétique au stade terminal). L'IC est également classée selon la fraction d'éjection ([FE] réduite, intermédiaire, préservée). Dans le diabète de type 2, qui est la forme de diabète la plus courante, plusieurs mécanismes physiopathologiques (p. ex. insulinorésistance et hyperglycémie) peuvent contribuer aux dommages causés au myocarde, et entraîner ainsi une cardiomyopathie diabétique. La FE et l'efficacité du médicament guident la prise en charge de l'IC et du diabète, et influencent les résultats observés chez les patients. Dans cet article, nous aborderons l'influence réciproque de l'IC et du diabète sur la physiopathologie de la maladie, la prise en charge et les résultats pour les patients. Nous soulignerons plus particulièrement le rôle des nouveaux antihyperglycémiants (p. ex. inhibiteurs du cotransporteur sodium-glucose de type 2 [SGLT2]) et des traitements contre l'IC (p. ex. inhibiteurs du système rénine-angiotensine-aldostérone) dans l'IC chez les patients atteints de diabète et d'IC.
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