Optimizing Management of Type 2 Diabetes and Its Complications in Patients With Heart Failure

Diabetes is an independent risk factor for heart failure (HF), with current trends indicating that nearly half of patients with type 2 diabetes will develop this complication. The presence of diabetes also worsens the prognosis of those with HF; people with both conditions have nearly double the mortality rate of those with HF whodonot havediabetes (1–3). Additional risk factors for the development of HF in people with diabetes include increasing age, longer duration of disease, insulin use, ischemic heart disease, peripheral artery disease, nephropathy, poor glycemic management, hypertension, obesity, and higher levels of N-terminal pro b-type natriuretic peptide (2,4,5). Recently, HF, including diabetic cardiomyopathy, has become a more well-recognized complicationofdiabetes,withaprevalence rivaling that of established cardiovascular disease (CVD). Clinical interest in the management of type 2 diabetes in the presence of HF has grown with the publication of cardiovascular outcomes trials (CVOTs) for sodium–glucose cotransporter 2 (SGLT2) inhibitors demonstrating HFrelated benefits and other trials showing heightened risk with the use of certain other antihyperglycemic therapies.