Department of Endocrinology and Nutrition, Hospital Germans Trias i Pujol, Badalona, Spain.
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
Cardiovasc Diabetol. 2024 Feb 12;23(1):65. doi: 10.1186/s12933-024-02136-y.
Heart failure (HF) is increasing at an alarming rate, primary due to the rising in aging, obesity and diabetes. Notably, individuals with type 1 diabetes (T1D) face a significantly elevated risk of HF, leading to more hospitalizations and increased case fatality rates. Several risk factors contribute to HF in T1D, including poor glycemic control, female gender, smoking, hypertension, elevated BMI, and albuminuria. However, early and intensive glycemic control can mitigate the long-term risk of HF in individuals with T1D. The pathophysiology of diabetes-associated HF is complex and multifactorial, and the underlying mechanisms in T1D remain incompletely elucidated. In terms of treatment, much of the evidence comes from type 2 diabetes (T2D) populations, so applying it to T1D requires caution. Sodium-glucose cotransporter 2 inhibitors have shown benefits in HF outcomes, even in non-diabetic populations. However, most of the information about HF and the evidence from cardiovascular safety trials related to glucose lowering medications refer to T2D. Glycemic control is key, but the link between hypoglycemia and HF hospitalization risk requires further study. Glycemic variability, common in T1D, is an independent HF risk factor. Technological advances offer the potential to improve glycemic control, including glycemic variability, and may play a role in preventing HF. In summary, HF in T1D is a complex challenge with unique dimensions. This review focuses on HF in individuals with T1D, exploring its epidemiology, risk factors, pathophysiology, diagnosis and treatment, which is crucial for developing tailored prevention and management strategies for this population.
心力衰竭（HF）的发病率正在以惊人的速度上升，主要原因是老龄化、肥胖和糖尿病的增加。值得注意的是，1 型糖尿病（T1D）患者患 HF 的风险显著升高，导致住院率增加和病死率升高。几种危险因素导致 T1D 患者发生 HF，包括血糖控制不佳、女性、吸烟、高血压、BMI 升高和白蛋白尿。然而，早期和强化血糖控制可以降低 T1D 患者 HF 的长期风险。糖尿病相关 HF 的病理生理学是复杂的和多因素的，T1D 中的潜在机制仍不完全清楚。在治疗方面，大部分证据来自 2 型糖尿病（T2D）人群，因此将其应用于 T1D 需要谨慎。钠-葡萄糖共转运蛋白 2 抑制剂在 HF 结局方面显示出益处，甚至在非糖尿病人群中也是如此。然而，关于 HF 的大部分信息和与降低血糖药物相关的心血管安全性试验的证据都涉及 T2D。血糖控制是关键，但低血糖与 HF 住院风险之间的联系需要进一步研究。T1D 中常见的血糖变异性是 HF 的独立危险因素。技术进步有可能改善血糖控制，包括血糖变异性，并可能在预防 HF 中发挥作用。总之，T1D 中的 HF 是一个具有独特维度的复杂挑战。本综述重点关注 T1D 患者的 HF，探讨其流行病学、危险因素、病理生理学、诊断和治疗，这对于为该人群制定量身定制的预防和管理策略至关重要。
