Sharma D C, Asirvatham Arthur, Singh Parminder
Department of Endocrinology, RNT Medical College, Udaipur, Rajasthan, India.
Arthur Asirvatham Hospital, Madurai, Tamil Nadu, India.
Indian J Endocrinol Metab. 2017 Jul-Aug;21(4):618-629. doi: 10.4103/ijem.IJEM_442_16.
Heart failure is the most common comorbidity of diabetes. The incidence of heart failure in patients with diabetes is about 9%-22%, which is four times higher Than that in patients without diabetes. Heart failure and diabetes are collectively associated with increased morbidity and mortality compared to either condition alone. Several epidemiological studies have demonstrated an increased risk of heart failure in patients with diabetes; moreover, poor glycemic control accounts for the increased risk of heart failure. At present, several oral (metformin, sulfonylureas, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, etc.) as well as injectable (insulins, glucagon-like peptide 1 receptor agonists) antidiabetic agents are available. However, optimal treatment strategy to achieve adequate glycemic control in patients with type 2 diabetes mellitus (T2DM) and heart failure has not been well studied. In the view of rising prevalence of heart failure in patients with diabetes mellitus, clinicians need to understand the potential implications of antidiabetic agents in patients with heart failure. A group of experts from across India were involved in a consensus meeting in Pondicherry during the National Insulin Summit in November 2015. They evaluated agents currently available for the treatment of diabetes looking at existing scientific evidence relevant to each class of therapy. In addition, the existing guidelines and prescribing literature available with all these agents were also reviewed. Findings from the expert evaluations were then factored into the national context incorporating personal experience and common clinical practices in India. The purpose of this consensus document is to assist the clinicians while treating patients with T2DM and heart failure.
心力衰竭是糖尿病最常见的合并症。糖尿病患者中心力衰竭的发生率约为9%-22%，是无糖尿病患者的四倍。与单独的任何一种疾病相比，心力衰竭和糖尿病共同导致发病率和死亡率增加。多项流行病学研究表明，糖尿病患者发生心力衰竭的风险增加；此外，血糖控制不佳是心力衰竭风险增加的原因。目前，有几种口服（二甲双胍、磺脲类、噻唑烷二酮类、二肽基肽酶-4抑制剂等）以及注射用（胰岛素、胰高血糖素样肽1受体激动剂）抗糖尿病药物可供使用。然而，在2型糖尿病（T2DM）合并心力衰竭患者中实现充分血糖控制的最佳治疗策略尚未得到充分研究。鉴于糖尿病患者中心力衰竭的患病率不断上升，临床医生需要了解抗糖尿病药物对心力衰竭患者的潜在影响。2015年11月，来自印度各地的一组专家在本地治里参加了全国胰岛素峰会期间的一次共识会议。他们根据与各类治疗相关的现有科学证据，评估了目前可用于治疗糖尿病的药物。此外，还审查了所有这些药物现有的指南和处方文献。然后，将专家评估的结果纳入印度的国情，融入个人经验和常见临床实践。本共识文件的目的是在临床医生治疗T2DM合并心力衰竭患者时提供帮助。
