Glucose and insulin abnormalities in patients with heart failure.

The proportion of patients with heart failure (HF) who have diabetes is increasing. Patients with HF not known to be diabetic are at high risk of developing insulin resistance and impaired glucose tolerance, although the true prevalence and incidence are unknown. Despite the frequent co-occurrence of these conditions we have little evidence to direct prevention, screening and management of these patients, although earlier identification is advocated. This clinical update will define abnormal glucose levels and insulin resistance, review the pathophysiology, prevalence and incidence of glucose and insulin abnormalities in patients with HF, discuss prognostic implications, and make recommendations for clinical practice.