Treatment of heart failure in patients with diabetes: clinical update.
Heart failure is an important problem for the growing number of persons afflicted with diabetes. Not only is HF more prevalent than in the non-diabetic population but also it carries a graver prognosis. Diabetic cardiomyopathy adds to the already increased risks for developing HF with hypertension and coronary heart disease, leading to systolic and diastolic dysfunction. As LV function deteriorates, increases in RAS and SNS activation may lead to progressive HF and premature death. The greater prevalence and increased mortality risk in diabetic patients supports the role of aggressive HF diagnosis and management, even in asymptomatic patients. Treatment strategies already established for HF have been shown to be effective in the diabetic population, including ACE inhibitors and beta-blockers. There is evidence that glycemic control is also important in improving clinical outcomes. The adverse effects of beta-blockade on carbohydrate and lipid metabolism and vasoconstriction may be circumvented by the use of carvedilol.
Bell
David S H
DS
Division of Endocrinology and Metabolism, The University of Alabama at Birmingham, School of Medicine, USA. dbell@endo.dom.uab.edu
D001786:Blood Glucose; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000009:adverse effects; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D004347:Drug Interactions; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
D001786:Blood Glucose; D002316:Cardiotonic Agents; D007004:Hypoglycemic Agents