Heart Failure: An Underappreciated Complication of Diabetes

Publication Date: June 1, 2022
Last Updated: July 5, 2022


  • Measurement of a natriuretic peptide or high-sensitivity cardiac troponin on at least a yearly basis to identify possible presence of stage B HF and to prognosticate risk for progression to symptomatic stages of the diagnosis.
  • Implementation of individualized management regarding further testing and introduction or avoidance of treatments following abnormal natriuretic peptide or high-sensitivity cardiac troponin results.
  • Use of guideline-directed medical therapy (GDMT) similar to patients with HF and without diabetes, including am angiotensin receptor-neprilysin inhibitor (ARNI) (or ACEi/ARB if ARNI is not prescribed), evidence-based beta-blockers, mineralocorticoid receptor antagonists, and SGLT2i.
  • Use of metformin, GLP1RA or insulin in individuals with T2D at high risk for/with established HF and for whom additional glycemic control is needed.
  • Consideration of diabetes technologies, cardiac rehabilitation programs and weight loss strategies as part of overall efforts to optimize care.
  • Ensuring women, individuals with T1D, and those with high-burdened social determinants of health have access to and are offered the same management framework.


• Both T1D and T2D increase the risk of developing HF across the entire range of glucose levels, but HF may be more
prevalent in people with T1D compared with T2D.

• There is increased incidence rate of HF among people with diabetes even after adjustment for age and comorbidities.

• HF may be the first presenting cardiovascular complication in individuals with diabetes.



Heart Failure: An Underappreciated Complication of Diabetes

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