Study links increasing severity of heart failure with increased risk of developing diabetes

May 20, 2014

New research published in Diabetologia (the journal of the European Association for the Study of Diabetes) shows that increasing severity of heart failure is associated with an increased risk of developing diabetes. The study is by Dr Malene Demant, Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark, and colleagues.

A previous study by the same authors has shown an increased risk of diabetes in patients with following a heart attack, but this new research aimed to analyse all patients with heart failure regardless of whether or not they had had a .

The study followed all Danish patients discharged from hospitalisation for first-time heart failure in 1997-2010, without prior use of oral diabetes drugs, until a claimed prescription for oral diabetes drugs, death, or 31 December 2010. The severity of each patient's heart failure was estimated via the dose of drugs (loop-diuretics) used to treat their condition.

In total, 99,362 patients were included and divided into five loop-diuretic dose groups: Group 1: 30,838 (31%) used no loop diuretics; Group 2, 24,389 (25%) used 40 mg or less per day; Group 3, 17,355 (17%) used 40-79 mg/day; Group 4, 11,973 (12%) used 80-159 mg/day; and Group 5 14,807 (15%) used 160 mg or more per day. A total of 7,958 patients (8%) developed diabetes.

Loop-diuretic dosages were associated with an increased risk of developing diabetes in a dose-dependent manner. The increased risk of developing diabetes for groups 2-5 versus group 1 (the reference group) was 2.06 times for group 2, 2.28 for group 3, 2.88 for group 4, and 3.02 for group 5. Thus patients in the group with the most severe heart failure (group 5) were three times more likely to develop diabetes than those with the least severe (group 1).

Patients who were also being treated with ACE inhibitors (angiotensin-converting-enzyme inhibitors) had a less pronounced increase in diabetes risk across all groups. The authors suggest this could be due to blockage of the neurohumeral axis, or improving cardiac function, or both. The clinical implications of this finding still need to be determined, say the authors.

In total, 62,565 (63%) patients died during the study period. Patients who developed diabetes were 16% more likely to die than those who did not develop diabetes. Increasing severity of heart failure, was, not surprisingly, also associated with further risk of death, with an increased risk in groups 2-5 compared with group 1: 14% for group 2; 17% for group 3; 29% for group 4 and 45% for group 5.

Dr Demant says: "From an epidemiological perspective, the poor prognosis associated with diabetes in patients with heart failure has confused researchers for 35 years. Even after adjustment for risk factors such as coronary artery disease and abnormal blood fats, several studies have over the years reported diabetes to be consistently associated with increased mortality."

She adds: "Our data add important insights to the understanding of the mechanisms underlying this poor prognosis, because it might be that the sickest patients are those who develop diabetes. Thus, diabetes may, in part, be a marker of heart failure severity in addition to being a causal risk factor for mortality in heart failure cohorts."

While the study does not explicitly examine mechanisms for the above effects, the authors discuss several possibilities, such as patients with heart failure having decreased cardiac output and thereby diminished oxygen, glucose and insulin distribution to peripheral muscular tissue which may lead to increased insulin resistance as well as decreased insulin release; lack of physical activity in those with the most severe heart failure, and also potential side effects of loop-diuretic drugs.

The authors conclude: "This study, based on nationwide data, suggests an increased risk of development of diabetes in patients with heart failure, with increasing loop-diuretic dosage used as a proxy for heart failure severity. It emphasises the need to monitor and treat patients with heart failure to prevent diabetes development. Future strategies for heart failure management should include increased awareness of risk of in patients with severe heart failure."

Explore further: RELAX-AHF: Poor diuretic response associated with worse clinical outcomes

Related Stories

RELAX-AHF: Poor diuretic response associated with worse clinical outcomes

May 17, 2014
Poor diuretic response is associated with worse in-hospital and post-discharge clinical outcomes, results of the RELAX-AHF trial reveal. The study also found that serelaxin has a neutral effect on diuretic response.

Antihypertensive ACEIs associated with reduced cardiovascular events, death

March 31, 2014
The blood pressure medication angiotensin-converting enzyme inhibitors (ACEIs) appear to reduce major cardiovascular events and death, as well death from all other causes, in patients with diabetes, while angiotensin II receptor ...

Intensive insulin provides survival

May 13, 2014
Long-term follow-up of the DIGAMI 1 trial – a landmark study of type 2 diabetes in Sweden – shows that intensive insulin treatment prolonged life by more than 2 years in patients with diabetes after a heart attack, compared ...

Heart failure hospitalization more than doubles in IBD flares

May 18, 2014
Heart failure hospitalisation more than doubles during inflammatory bowel disease (IBD) flares, according to a study of more than 5 million Danish people. The research was presented today at the Heart Failure Congress 2014, ...

Heart risks of glucose-lowering drugs being overlooked in clinical trials

March 12, 2014
Why is heart failure not more rigorously assessed in clinical trials of antidiabetes drugs? In a Personal View, published in The Lancet Diabetes & Endocrinology journal, Professor John McMurray of The University of Glasgow ...

Sleeping pills increase CV events in heart failure patients

May 17, 2014
Sleeping pills increase the risk of cardiovascular events in heart failure patients by 8-fold, according to research from Japan. The study was presented today at the Heart Failure Congress 2014, held 17-20 May in Athens, ...

Recommended for you

A step closer to a cure for adult-onset diabetes

October 23, 2017
In healthy people, exosomes – tiny structures secreted by cells to allow intercellular communication – prevent clumping of the protein that leads to type 2 diabetes. Exosomes in patients with the disease don't have the ...

Diabetes pill might replace injection to control blood sugar

October 17, 2017
(HealthDay)— An injectable class of diabetes medication—called glucagon-like peptide-1 or GLP-1—might one day be available in pill form, research suggests.

Skimping on sleep may contribute to gestational diabetes

October 17, 2017
The amount of time spent sleeping in the United States has dropped significantly in the past twenty years with almost a quarter of women and 16 percent of men experiencing insufficient sleep. Now, a new study has found that ...

Artificial pancreas performs well in clinical trial

October 16, 2017
During more than 60,000 hours of combined use of a novel artificial pancreas system, participants in a 12-week, multi-site clinical trial showed significant improvements in two key measures of well-being in people living ...

Omega-6 fats may help prevent type 2 diabetes

October 11, 2017
The risk of developing type 2 diabetes could be significantly reduced by eating a diet rich in omega-6 polyunsaturated fats, a new study suggests.

Where there's type 1 diabetes, celiac disease may follow

October 10, 2017
(HealthDay)—Parents of young children with type 1 diabetes need to be on the lookout for symptoms of another autoimmune condition—celiac disease, new research suggests.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.