The Most Frequently Overlooked Effect of Type 2 Diabetes

Retinopathy, kidney disease and nerve damage are often highlighted as the most undesirable microvascular effects of type 2 diabetes, but there’s another more sinister complication that demands greater attention — heart failure leading to increased mortality.

According to specialists Dr. David S.H. Bell, Dr. Aaron Vinik, PhD, FCP, MACP, FACE, and Dr. Richard E. Gilbert, PhD, FRCPC, there is enough evidence available to convince endocrinologists to become more rigorous in screening for heart failure and increased mortality with symptomatic patients. There is also sufficient evidence for doctors to consider treating the condition to mitigate poor outcomes often seen in these patients.

The trio of specialists presented an in-depth symposium on diabetic heart failure, Heart Failure: The Frequent, Forgotten and Often Fatal Complication of Type 2 Diabetes, at the American Association of Clinical Endocrinologists’ (AACE’s) 26^th Annual Scientific and Clinical Congress in Austin, TX.

“It’s not widely realized how common this condition is,” Bell said. “Somewhere between 40% and 45% of people in this country with diabetes suffer heart failure versus 12% of non-diabetics. And depending on the degree of glycemic control, the worse the mortality is.”

Bell highlighted studies that examined the complex effect of diabetes and contributing factors to the three causes of heart failure: coronary artery disease, left ventricular hypertrophy (LVH), which occurs in approximately 65% of people with type 2 diabetes, and diabetic cardiomyopathy, a distinct pathology that is closely associated with the microvascular complications of diabetes.

While anti-heart failure therapies such as angiotensin-converting-enzyme inhibitors and others work well in individuals with diabetes as compared to those without the disease, the glucose-lowering drug dipeptidylpeptidase-4 (DPP4) inhibitors saxagliptin has been found to cause an increase in heart failure in diabetes patients, Gilbert said.

He went on to highlight the relation between glycemic control and heart failure risk, and focused on the state of knowledge regarding the beneficial effects of the various types of anti-hyperglycemic drugs.

Vinik highlighted supplemental insight regarding his research in autonomic neuropathy, which he called one of the most overlooked type 2 diabetes complications contributing to the high incidence of heart failure in diabetic patients, where damage to the body’s blood vessels extends to involuntary nerves that stimulate the heart and blood vessels, resulting in heart rate and vascular abnormalities.

According to the specialists, autonomic system dysfunction can help doctors predict cardiovascular risk and sudden death in type 2 diabetes patients, but it also occurs in prediabetes, and thus offers opportunities for early intervention.

“Important advances in technology during the past decade now make it possible to identify these early stages of autonomic dysfunction with the use of objective standardized measures, allowing earlier intervention when reversal of the condition is still possible,” according to an AACE statement.

Read the AACE list of press releases.