Heart Failure: An Underappreciated Complication of Diabetes. A Consensus Report of the American Diabetes Association
Traditionally, the prevention and management of chronic complications in individuals with type 1 (T1D) and type 2 diabetes (T2D) has been focused on of nephropathy, retinopathy, neuropathy, and atherosclerotic cardiovascular disease (including ischemic heart disease, stroke or peripheral vascular disease) (1). However, heart failure (HF) has been recognized as a common complication of diabetes, with a prevalence of up to 22% in individuals with diabetes and increasing incidence rates (2–4). This recognition stems in part from trials focused on cardiovascular safety of newer drugs to treat diabetes. Data also suggest HF may develop in individuals with diabetes even in the absence of hypertension, coronary heart disease, or valvular heart disease and, as such, represents a major cardiovascular complication in this vulnerable population (5). Given that during the past decade, the prevalence of diabetes (particularly T2D) has risen by 30% globally (6) (with prevalence expected to increase further), the burden of HF on the health care system will continue to rise.
The scope of this American Diabetes Association (ADA) consensus report with designated representation from the American College of Cardiology (ACC) is to provide clear guidance and to recommend best approaches to general internists, family physicians, and endocrinologists for HF screening, diagnosis, and management in individuals with T1D, T2D, or prediabetes to mitigate the risks of serious complications, leveraging prior policy statements by the ACC (7) and American Heart Association (AHA) (2). This consensus report was developed by the writing group convened by ADA with representation from ACC through a series of conference calls, emails, and independent work from March 2021 through March 2022.
Traditionally, the prevention and management of chronic complications in individuals with type 1 (T1D) and type 2 diabetes (T2D) has been focused on of nephropathy, retinopathy, neuropathy, and atherosclerotic cardiovascular disease (including ischemic heart disease, stroke or peripheral vascular disease) (1). However, heart failure (HF) has been recognized as a common complication of diabetes, with a prevalence of up to 22% in individuals with diabetes and increasing incidence rates (2–4). This recognition stems in part from trials focused on cardiovascular safety of newer drugs to treat diabetes. Data also suggest HF may develop in individuals with diabetes even in the absence of hypertension, coronary heart disease, or valvular heart disease and, as such, represents a major cardiovascular complication in this vulnerable population (5). Given that during the past decade, the prevalence of diabetes (particularly T2D) has risen by 30% globally (6) (with prevalence expected to increase further), the burden of HF on the health care system will continue to rise.
The scope of this American Diabetes Association (ADA) consensus report with designated representation from the American College of Cardiology (ACC) is to provide clear guidance and to recommend best approaches to general internists, family physicians, and endocrinologists for HF screening, diagnosis, and management in individuals with T1D, T2D, or prediabetes to mitigate the risks of serious complications, leveraging prior policy statements by the ACC (7) and American Heart Association (AHA) (2). This consensus report was developed by the writing group convened by ADA with representation from ACC through a series of conference calls, emails, and independent work from March 2021 through March 2022.
