Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Bremser Strasse 79, D-67063 Ludwigshafen, Germany.
Eur J Heart Fail. 2012 Dec;14(12):1389-400. doi: 10.1093/eurjhf/hfs136. Epub 2012 Sep 13.
Patients with type 2 diabetes are at high risk for developing heart failure. Evidence-based treatment recommendations with respect to the specific benefits or possible hazards of antidiabetic treatment are scarce.
In a systematic search we only identified randomized, controlled trials for thiazolidinediones. Further evidence is largely based on subgroup analyses of larger intervention studies in mostly systolic heart failure, on observational studies, or on registries. Acknowledging this lack of data, hyperglycaemia should be treated to appropriate guideline-recommended targets and hypoglycaemia avoided until this evidence becomes available. Thiazolidinediones should not be used because of an increased event rate in diabetic patients with established heart failure and a large increase in incident heart failure. All other glucose-lowering strategies might be used in patients with diabetes and heart failure, but specific precautions must be considered.
The documented lack of data calls for specific trials, as diabetes and heart failure as well as their co-morbidities are highly prevalent and are becoming even more important with an increasing prevalence of obesity and an ageing population.
2 型糖尿病患者发生心力衰竭的风险很高。关于抗糖尿病治疗的具体益处或潜在危害，目前缺乏循证治疗建议。
在系统搜索中，我们仅发现了噻唑烷二酮类药物的随机对照试验。进一步的证据主要基于更大的干预研究中收缩性心力衰竭的亚组分析、观察性研究或注册研究。鉴于缺乏数据，应将高血糖症治疗至适当的指南推荐目标，并避免低血糖症，直到获得这些证据。由于在患有心力衰竭的糖尿病患者中事件发生率增加，以及心力衰竭发生率大幅增加，因此不应使用噻唑烷二酮类药物。所有其他降低血糖的策略都可用于患有糖尿病和心力衰竭的患者，但必须考虑特定的预防措施。
有记录的缺乏数据需要进行特定的试验，因为糖尿病和心力衰竭及其合并症的患病率很高，随着肥胖症和人口老龄化的患病率增加，其重要性变得更为突出。
