Heart failure therapy in patients with diabetes

The great interest in the problem “Heart failure” (HF) by the diabetolo­gist has been born in recent years and is mainly linked to the availabil­ity of new antidiabetic drugs which have shown a significant benefit in reducing hospitalizations for heart failure and cardiovascular mortality. Diabetes patients have more than double the risk of developing HF compared to patients without diabetes. The Framingham study has shown that diabetes increases the risk of heart failure up to 2 times in men and 5 times in women compared to controls over age. In addition, 12% of patients with DMT2 have heart failure and 30% of patients with heart failure are diabetic. Hospitalization for HF is associated with very high rates of both post-dis­charge mortality and new hospitalizations. Readmission rates for clinically stable patients discharged after recent hospitalization for HF are approximately 25% at 6 months and all-cause mortality exceeds 30% at 1 year. In particular, a worse prognosis and a longer hospital stay are associated with hospitalized diabetes patients. There is a close correlation between metabolic compensation and HF. In fact, in patients with diabetes a 1% increase in HbA1c is associated with an 8% increase in the risk of HF and still the improvement of the glycometabolic control reduces the risk of HF (in the UKPDS the 1% re­duction in HbA1c was associated with a 16% reduction in the risk of HF occurring). KEY WORDS T2DM; heart failure; SGLT2-inhibitors; diabetic cardiomyopathy.