First Propaedeutic Department of Internal Medicine and Diabetes Center, National Kapodistrian University of Athens, Laiko University Hospital, 11527 Athens, Greece.
Research Laboratory Christeas Hall, Medical School, National Kapodistrian University of Athens, 10679 Athens, Greece.
Int J Environ Res Public Health. 2019 Dec 24;17(1):155. doi: 10.3390/ijerph17010155.
Heart failure (HF) represents an important cardiovascular complication of type 2 diabetes mellitus (T2DM) associated with substantial morbidity and mortality, and is emphasized in recent cardiovascular outcome trials (CVOTs) as a critical outcome for patients with T2DM. Treatment of T2DM in patients with HF can be challenging, considering that these patients are usually elderly, frail and have extensive comorbidities, most importantly chronic kidney disease. The complexity of medical regimens, the high risk clinical characteristics of patients and the potential of HF therapies to interfere with glucose metabolism, and conversely the emerging potential of some antidiabetic agents to modulate HF outcomes, are only some of the challenges that need to be addressed in the framework of a team-based personalized approach. The presence of established HF or the high risk of developing HF in the future has influenced recent guideline recommendations and can guide therapeutic decision making. Metformin remains first-line treatment for overweight T2DM patients at moderate cardiovascular risk. Although not contraindicated, metformin is no longer considered as first-line therapy for patients with established HF or at risk for HF, since there is robust scientific evidence that treatment with other glucose-lowering agents such as sodium-glucose cotransporter 2 inhibitors (SGLT2i) should be prioritized in this population due to their strong and remarkably consistent beneficial effects on HF outcomes.
心力衰竭（HF）是 2 型糖尿病（T2DM）的一种重要心血管并发症，与较高的发病率和死亡率相关，在最近的心血管结局试验（CVOTs）中被强调为 T2DM 患者的一个关键结局。考虑到这些患者通常年龄较大、身体虚弱且合并症广泛，尤其是慢性肾脏病，HF 患者的 T2DM 治疗具有挑战性。治疗方案复杂，患者的高临床风险特征以及 HF 治疗药物可能干扰葡萄糖代谢，而一些新型降糖药物可能会影响 HF 结局，这些只是需要在基于团队的个性化方法框架内解决的一些挑战。已存在 HF 或未来有发生 HF 的高风险，影响了最近的指南建议，并可指导治疗决策。对于超重且心血管风险处于中度水平的 T2DM 患者，二甲双胍仍为一线治疗药物。尽管并非禁忌，但对于已存在 HF 或有 HF 风险的患者，不再将二甲双胍视为一线治疗药物，因为有强有力的科学证据表明，对于此类人群，应优先使用其他降糖药物，如钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i），因为它们对 HF 结局具有强大且显著一致的有益影响。
