Congestive heart failure in type 2 diabetes: prevalence, incidence, and risk factors.
OBJECTIVE
To estimate the prevalence and incidence of congestive heart failure (CHF) in populations with and without type 2 diabetes and to identify risk factors for diabetes-associated CHF.


METHODS
We searched the inpatient and outpatient electronic medical records of 9,591 individuals diagnosed with type 2 diabetes before 1 January 1997 and those of an age- and sex-matched control group without diabetes for a diagnosis of CHF. Among those without a baseline diagnosis of CHF, we searched forward for 30 months for incident cases of CHF. We constructed multiple logistic regression models to identify risk factors for both prevalent and incident CHF.


RESULTS
CHF was prevalent in 11.8% (n = 1,131) of diabetic subjects and 4.5% (n = 435) of control subjects at baseline. We observed incident cases of CHF in 7.7% of diabetic subjects free of CHF at baseline (650 of 8,460) and in 3.4% of control subjects (314 of 9,156). In diabetic subjects, age, diabetes duration, insulin use, ischemic heart disease, and elevated serum creatinine were independent risk factors for both prevalent and incident CHF. Better glycemic control at baseline, and improved glycemic and blood pressure control at follow-up predicted the development of CHF.


CONCLUSIONS
Despite controlling for age, duration of diabetes, presence of ischemic heart disease, and presence of hypertension, insulin use was associated with both prevalent and incident CHF. Why insulin use and better glycemic control both at baseline and follow-up independently predicted CHF deserves further study.
Nichols
G A
GA
Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227-1098, USA. greg.nichols@kp.org
Hillier
T A
TA
Erbey
J R
JR
Brown
J B
JB
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D001835:Body Weight; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology*; D006753:Hospital Records; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000503:physiopathology; D009922:Oregon / Q000453:epidemiology; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors
D006442:Glycated Hemoglobin