Southside Endocrinology, Birmingham, Alabama.
Diabetes and Thyroid Associates, Birmingham, Alabama.
Diabetes Obes Metab. 2019 Jun;21(6):1277-1290. doi: 10.1111/dom.13652. Epub 2019 Mar 6.
In people with type 2 diabetes the frequency of heart failure (HF) is increased and mortality from HF is higher than with non-diabetic HF. The increased frequency of HF is attributable to the cardiotoxic tetrad of ischaemic heart disease, left ventricular hypertrophy, diabetic cardiomyopathy and an extracellular volume expansion resistant to atrial natriuretic peptides. Activation of the renin-angiotensin-aldosterone system and sympathetic nervous systems results in cardiac remodelling, which worsens cardiac function. Reversal of remodelling can be achieved, and cardiac function improved in people with HF with reduced ejection fraction (HFrEF) by treatment with angiotensin-converting enzyme inhibitors and β-blockers. However, with HF with preserved ejection fraction (HFpEF), only therapy for the underlying risk factors helps. Blockers of mineralocorticoid receptors may be beneficial in both HFrEF and HFpEF. Glucose-lowering drugs can have a negative effect (insulin, sulphonylureas, dipeptidyl peptidase-4 inhibitors and thiazolidinediones), a neutral effect (α-glucosidase inhibitors and glucagon-like peptide-1 receptor agonists) or a positive effect (sodium-glucose co-transporter-2 inhibitors and metformin).
在 2 型糖尿病患者中，心力衰竭 (HF) 的发生率增加，HF 的死亡率高于非糖尿病性 HF。HF 发生率增加归因于缺血性心脏病、左心室肥厚、糖尿病心肌病和对心房利钠肽扩张细胞外容量有抗性的心脏毒性四联症。肾素-血管紧张素-醛固酮系统和交感神经系统的激活导致心脏重构，从而使心脏功能恶化。通过使用血管紧张素转换酶抑制剂和β受体阻滞剂，可逆转重构并改善射血分数降低的心力衰竭（HFrEF）患者的心脏功能。然而，对于射血分数保留的心力衰竭（HFpEF），只有针对潜在风险因素的治疗才有帮助。盐皮质激素受体阻滞剂可能对 HFrEF 和 HFpEF 均有益。降糖药物可能会产生负面影响（胰岛素、磺酰脲类药物、二肽基肽酶-4 抑制剂和噻唑烷二酮类药物）、中性影响（α-葡萄糖苷酶抑制剂和胰高血糖素样肽-1 受体激动剂）或积极影响（钠-葡萄糖共转运蛋白-2 抑制剂和二甲双胍）。
