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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses the pathophysiological links between diabetes and heart failure (HF), treatment of diabetes to prevent HF, and treatment of diabetes in patients with HF.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EMichael R. MacDonald, MD, Golden Jubilee National Hospital, Glasgow, Scotland, United Kingdom, discussed the pathophysiological links between diabetes and heart failure (HF), treatment of diabetes to prevent HF, and treatment of diabetes in patients with HF.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe RESOLVD substudy included 663 patients with HF, 27% of whom were known to have diabetes. Of those thought to be non-diabetic, 11% had diabetes, 12% had impaired glucose tolerance, and 34% had insulin resistance [Yan RT et al. \u003Cem\u003EAm J Cardiol\u003C\/em\u003E 2005]. The Framingham study reported a substantially increased risk of HF in patients with diabetes.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPathophysiological Links\u003C\/h2\u003E\n         \u003Cp id=\u0022p-4\u0022\u003ENumerous studies have shown that diabetes is an independent predictor of worse prognosis in patients with HF. Conversely, HF worsens the prognosis in patients with diabetes [Bertoni HG et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2004]. Additionally, diabetes and HF can each lead to the other condition. Insulin resistance is common in patients with HF and is independent of HF etiology; it predicts incident HF, reduced functional capacity, more severe symptoms, and reduced survival [Doehner W. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2008]. At the time of diabetes diagnosis, 40% of patients have macroangiopathy, 40% have albuminuria, 15% have retinopathy, 50% have hypertension, and 50% have hypertriglyceridemia [Meeuwisse-Pasterkamp SH et al. \u003Cem\u003EExpert Rev Cardiovasc Ther\u003C\/em\u003E 2008]. Possible mechanisms for insulin resistance in HF include age, genetic factors, diet and decreased exercise, endothelial dysfunction, impaired tissue performance, oxidative stress, and humoral factors [Doehner W. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2008]. Several studies have demonstrated evidence for a diabetic cardiomyopathy. The CHARM study reported an increased incidence of cardiovascular (CV) death or hospitalization due to HF (p=0.0009) and hospitalization due to HF (p=0.0029) in patients with diabetes versus those without diabetes [MacDonald MR et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2008].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ETreatment of Diabetes and HF\u003C\/h2\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe CHARM study showed that increasing HbA1C is a progressive risk factor for CV death, worsening HF, and death. Results of observational studies are inconsistent, however, and no randomized trials have evaluated the effect of reducing HbA1C on HF outcomes.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EA case-control study showed that metformin is the only diabetes drug that improves outcomes in patients with diabetes and HF [MacDonald MR et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2010]. Sulfonylureas increase insulin release but promote fluid retention and can cause hypoglycemia. Insulin therapy is associated with a higher incidence of HF, as are thiazolidinediones.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EGlucose-like peptide-1 (GLP-1) receptors are present in myocardium, and GLP-1 mimetics may have benefits in HF. They may alter substrate utilization and have beneficial effects on endothelium. GLP-1 mimetics have an inotropic effect in animals. In addition, a study in 12 HF patients showed that the GLP-1 mimetic exenatide improved ejection fraction, maximal O\u003Csub\u003E2\u003C\/sub\u003E uptake, 6-minute walk test, and quality of life.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EDr. MacDonald proposed a glycemic control strategy beginning with lifestyle interventions, followed by the addition of metformin, sulfonylurea or dipeptidyl peptidase-4 (DPP-4) inhibitor, and a DPP-4 inhibitor or an a-glucosidase inhibitor or a GLP-1 mimetic (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/3\/7\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Glycemic Control Strategy.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1153046538\u0022 data-figure-caption=\u0022Glycemic Control Strategy.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/3\/7\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/3\/7\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/3\/7\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13989\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003EGlycemic Control Strategy.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from MR MacDonald, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EPatients with diabetes often develop HF, which places a substantial burden on healthcare resources. Diabetes appears to directly affect the myocardium, but pathophysiologic data for humans are not available. HF patients should be screened for diabetes. Prospective studies examining therapeutic strategies in patients with diabetes and acute or chronic HF are warranted.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/3\/7.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzne1q\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzne1q\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}