Reducing Heart Failure Risk in Diabetes Mellitus: Review of Therapeutics

Diabetes mellitus (DM) and heart failure (HF) are closely linked: patients with diabetes are more likely to develop HF, and those with HF are more likely to develop diabetes. Diabetic patients have an increased risk of developing HF because of the abnormal cardiac handling of glucose and free fatty acids, and because of the effect of the metabolic derangements of diabetes on the cardiovascular system. When the two diseases are considered separately, HF has a much worse prognosis than diabetes mellitus; thus, treatment of HF is a priority in this patient group. Many drugs are now available to help people with diabetes achieve glycemic control. However, as the management of diabetes becomes more personalized, the next challenge will be to identify therapeutic strategies that will not only achieve and keep up glycemic control, but will also reverse existing problems. Given the high prevalence of HF in DM, there is an urgent need to advance this field in order to identify robust strategies that will not only enhance long-term results in subjects with DM and HF, but will also reduce the likelihood of developing HF in the first place. Newer therapies, such as sodium-glucose transport protein-2 inhibitors (SGLT-2 I) and sacubitril or valsartan, have shown promise in lowering the risk of heart failure in diabetics. This review will summarize novel therapeutics for lowering the risk of HF in diabetic patients.