medwireNews: Results of a study published in JACC: Heart Failure suggest that glycemic control and drug treatment have complex associations with adverse outcomes among patients with heart failure (HF) and type 2 diabetes.
“Patients with [type 2 diabetes] are at risk for developing HF over time, and incident HF is associated with a uniquely poor prognosis in this cohort,” explain Javed Butler (Stony Brook University School of Medicine, New York) and Muthiah Vaduganathan (Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA) in an accompanying editorial comment.
The current findings “further our understanding of the complex interplay between [type 2 diabetes] and HF,” they add.
In an analysis of almost 49,000 HF patients from a UK database cohort, Claire Lawson (Leicester Diabetes Centre, UK) and fellow researchers found that the magnitude of increased risk for hospitalization and mortality associated with diabetes varied according to glycated hemoglobin (HbA1c) levels.
In fact, there was a U-shaped relationship. HF patients with type 2 diabetes who had HbA1c levels above 9.5% had the highest risk for hospitalization compared with those without diabetes (odds ratio [OR]=1.75 after adjustment for confounders), followed by patients with HbA1c levels below 5.5% (OR=1.42), while those with levels of 5.5–6.4% and 6.5–7.5% had the smallest increase in risk (OR=1.13 for both groups).
The team also observed a similar pattern for all-cause mortality, with the largest increase in mortality risk seen among patients with HbA1c levels above 9.5% and below 5.5%.
“This disconnect between glycemic indices and clinical outcomes in high-risk patients emphasizes the role of exploring therapeutic pathways beyond optimizing glycemic status alone in this population,” remark Butler and Vaduganathan.
Prognosis also varied according to drug treatment. Compared with patients without diabetes, Lawson and colleagues identified “an incremental and significant increase” in the risk for hospitalization among patients in different treatment groups. Diabetes patients who did not receive medication had the smallest rise in risk, and an increasing risk was observed with those receiving oral antidiabetic agents alone, followed by antidiabetic agents plus insulin, and insulin alone (OR=1.12, 1.34, 1.36, and 1.61, respectively).
Patients receiving insulin alone also had the highest risk for mortality compared with nondiabetic patients (OR=1.43), followed by those not receiving drug treatment (OR=1.31), whereas those treated with oral antihyperglycemic agents alone or with insulin had the lowest risk (OR=1.16 and 1.19, respectively).
The increased risk for adverse outcomes among patients receiving insulin was “consistent with previous hospital HF studies,” say the study authors.
“This group tends to indicate patients with poor control in [type 2 diabetes] with more severe metabolic disturbances and increased severity,” whereas the high risk in the no medication group “likely reflects end-stage HF severity where deprescribing may occur,” they explain.
And the team concludes: “Glycemic control and drug treatments are routinely recorded in the general HF population with [type 2 diabetes] and provide important risk indicators of imminent hospitalization and all-cause death.”
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