Polyclinique d'Aubervilliers, Aubervilliers and Paris Nord University, Bobigny, France.
Cardiovasc Diabetol. 2024 Sep 28;23(1):354. doi: 10.1186/s12933-024-02436-3.
Prevalence of heart failure (HF) and diabetes are markedly increasing globally. In a population of HF patients, approximately 40% have diabetes which is associated with a more severe HF, poorer cardiovascular outcomes and higher hospitalization rates for HF than HF patients without diabetes. Similar trends were shown in HF patients with prediabetes. In addition, the association between HF and renal function decline was demonstrated in patients with or without diabetes. However, the exact prevalence of dysglycemia in HF patients requires further investigation aiming to clarify the most accurate test to detect dysglycemia in this population. The relationship between HF and diabetes is complex and probably bidirectional. In one way, patients with diabetes have a more than two-fold risk of developing incident HF with reduced or preserved ejection fraction than those without diabetes. In the other way, patients with HF, when compared with those without HF, show an increased risk for the onset of diabetes due to several mechanisms including insulin resistance (IR), which makes HF emerging as a precursor for diabetes development. This article provides epidemiological evidence of undetected dysglycemia (prediabetes or diabetes) in HF patients and reviews the pathophysiological mechanisms which favor the development of IR and the risks associated with these disorders in HF patients. This review also offers a discussion of various strategies for the prevention of diabetes in HF patients, based first on fasting plasma glucose and HbA measurement and if normal on an oral glucose tolerance test as diagnostic tools for prediabetes and unknown diabetes that should be performed more extensively in those patients. It discusses the implementation of diabetes prevention measures and well-structured management programs for HF patients who are generally overweight or obese, as well as current pharmacotherapeutic options for prediabetes, including sodium-glucose cotransporter 2 inhibitors which are among the pillars of HF treatment and which recently showed a benefit in the reduction of incident diabetes in HF patients. Thus, there is an urgent need of routine screening for dysglycemia in all HF patients, which should contribute to reduce the incidence of diabetes and to treat earlier diabetes when already present.
心力衰竭（HF）和糖尿病的患病率在全球范围内显著增加。在 HF 患者人群中，约有 40%患有糖尿病，这与 HF 患者的 HF 更严重、心血管结局更差以及 HF 住院率更高有关。在有糖尿病前期的 HF 患者中也显示出类似的趋势。此外，在有或没有糖尿病的 HF 患者中，都观察到 HF 与肾功能下降之间存在关联。然而，HF 患者中糖代谢异常的确切患病率需要进一步研究，旨在阐明检测该人群中糖代谢异常的最准确检测方法。HF 和糖尿病之间的关系是复杂的，可能是双向的。一方面，与无糖尿病患者相比，有糖尿病的患者发生射血分数保留或降低的 HF 的风险增加了一倍以上。另一方面，与无 HF 患者相比，HF 患者由于胰岛素抵抗（IR）等多种机制，发生糖尿病的风险增加，这使得 HF 成为糖尿病发展的前驱。本文提供了 HF 患者中未检测到的糖代谢异常（糖尿病前期或糖尿病）的流行病学证据，并回顾了有利于 IR 发展的病理生理机制以及这些疾病在 HF 患者中的相关风险。这篇综述还讨论了 HF 患者预防糖尿病的各种策略，首先基于空腹血糖和 HbA 测量，如果正常，则进行口服葡萄糖耐量试验作为糖尿病前期和未知糖尿病的诊断工具，这些工具应在这些患者中更广泛地进行。它讨论了在超重或肥胖的 HF 患者中实施糖尿病预防措施和结构化管理计划的情况，以及目前用于糖尿病前期的药物治疗选择，包括钠-葡萄糖共转运蛋白 2 抑制剂，这些抑制剂是 HF 治疗的基石之一，最近在减少 HF 患者新发糖尿病方面显示出获益。因此，迫切需要对所有 HF 患者进行常规的糖代谢异常筛查，这有助于降低糖尿病的发病率，并在已经存在糖尿病时及早治疗。
