ESC: Treatment Options for Heart Failure in Type 2 Diabetes

Chest x ray
Chest x ray
The position statement presents treatment options for patients with type 2 diabetes and heart failure and summarizes recent evidence of heart failure prevention with medications used to treat type 2 diabetes.

The Heart Failure Association of the European Society of Cardiology has released a position paper detailing different heart failure treatment options for patients with type 2 diabetes in the European Journal of Heart Failure.

Metformin is typically recommended as the first choice in treating type 2 diabetes in patients with heart failure, and sulfonylureas and insulin typically follow, despite their lack of concrete safety in patients with heart failure. Treating heart failure in patients with type 2 diabetes is not currently subject to restrictions, as research has suggested that no single heart failure therapy is significantly more effective in the general population than any other.

Both dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like preptide-1 receptor agonists have been ineffective in reducing the risk for heart failure hospitalization, although a DPP-4 inhibitor called saxagliptin actually appears to increase the risk. Rosiglitazone and pioglitazone similarly increase risk in those with, or in danger of experiencing, heart failure. Canagliflozin and empagliflozin, 2 sodium-glucose co-transporter-2 inhibitors, have demonstrated a lower risk for heart failure hospitalization for patients with established or potential cardiovascular disease. The possible effectiveness of these inhibitors for patients who do not have type 2 diabetes with preserved (HFpEF) and reduced ejection fraction (HFrEF) heart failure should become clear with results from several trials in progress.

Type 2 diabetes is coexistent with both HFpEF and HFrEF in 30 to 40% of patients. This condition is correlated with cardiovascular and all-cause mortality, as well as an increased risk for hospitalization for heart failure. Among patients with type 2 diabetes, arterial hypertension, artery disease, and myocardial detriment due to type 2 diabetes are the main causes of heart failure.

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Researchers confirm that there is “significantly higher risk of adverse outcomes in patients with [heart failure] and [type 2 diabetes mellitus], including a higher risk for hospitalization and rehospitalization for [heart failure], as well as increased all-cause and CV mortality, independent of [heart failure] aetiology or phenotype (ie HFrEF and HFpEF).”


Seferović PM, Petrie MC, Filippatos GS, et al. Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology [published online March 8, 2018]. Eur J Heart Fail. doi: 10.1002/ejhf.1170