Heart Failure as Type 2 Diabetes Complication Deserves More Scrutiny, Panel of Endocrinologists Declares

Friday, May 5, 2017 11:27 am EDT


"Somewhere between 40 and 45 percent of people in this country with diabetes suffer heart failure versus 12 percent of non-diabetics. And depending on the degree of glycemic control, the worse the mortality is."

AUSTIN, Texas--(BUSINESS WIRE)--While much attention is given to the microvascular effects of type 2 diabetes (T2D) – diabetic retinopathy, kidney disease, nerve damage – and the macrovascular consequences that include stroke, heart attacks and peripheral vascular disease, there is a seventh and more sinister complication of diabetes that demands greater attention: heart failure leading to increased mortality.

That was the message delivered today by a trio of specialists during an in-depth symposium presented at the American Association of Clinical Endocrinologists’ 26th Annual Scientific and Clinical Congress.

In the session “Heart Failure: The Frequent, Forgotten and Often Fatal Complication of Type 2 Diabetes,” Dr. David S.H. Bell, who has performed clinical trials on the effects of angiotensin II receptor blockers (ARBs) in diabetes patients with diastolic dysfunction, suggested the available evidence should propel endocrinologists to become more rigorous in screening for the complication with symptomatic patients and consider treating it to mitigate the poor outcomes often seen in these patients.

“It’s not widely realized how common this condition is,” Dr. Bell noted. “Somewhere between 40 and 45 percent of people in this country with diabetes suffer heart failure versus 12 percent of non-diabetics. And depending on the degree of glycemic control, the worse the mortality is.”

He highlighted studies that examined the complex effect of diabetes and contributing factors to the three causes of the heart failure, including coronary artery disease, left ventricular hypertrophy (LVH, which occurs in approximately 65 percent of people with type 2 diabetes), and diabetic cardiomyopathy, a distinct pathology that is closely associated with the microvascular complications of the diabetes.

Paradoxically, while anti-heart failure therapies such as angiotensin-converting-enzyme inhibitors and others work similarly well in individuals with diabetes as compared to those without the disease, the glucose-lowering drug dipeptidylpeptidase-4 (DPP4) inhibitors saxagliptin has been found to cause an increase in heart failure in diabetes patients, said the second presenter of the session, researcher Dr. Richard E. Gilbert, PhD, FRCPC.

Considered an expert in the knowledge of kidney disease and diabetes as major, independent risk factors for the development of heart failure, Dr. Gilbert highlighted the relation between glycemic control and heart failure risk, focusing on the state of knowledge regarding the detrimental and beneficial effects of the various types of anti-hyperglycemic drugs.

Dr. Aaron Vinik, PhD, FCP, MACP, FACE, presented details regarding his research on autonomic neuropathy, one of the most overlooked T2D complications contributing to the high incidence of heart failure in the diabetic patients, in which damage to the body’s blood vessels extends to those involuntary nerves that stimulate the heart and blood vessels, resulting in heart rate and vascular abnormalities.

Autonomic system dysfunction is a predictor of cardiovascular risk and sudden death in T2D patients, but also occurs in prediabetes, and thus offers opportunities for early intervention, Dr. Vinik noted. Important advances in technology during the past decade now make it possible to identify these early stages of autonomic dysfunction with the use of objective standardized measures, allowing earlier intervention when reversal of the condition is still possible.

Dr. Bell, Dr. Gilbert and Dr. Vinik will discuss highlights of their session presentation during a press briefing on Friday, May 5th, from 12:15 p.m. to 1:15 p.m. at the AACE Annual Congress Press Room, Austin Convention Center, Level 4, Room 14.

About the American Association of Clinical Endocrinologists (AACE)

The American Association of Clinical Endocrinologists (AACE) represents more than 7,000 endocrinologists in the United States and abroad. AACE is the largest association of clinical endocrinologists in the world. A majority of AACE members are certified in endocrinology, diabetes and metabolism and concentrate on the treatment of patients with endocrine and metabolic disorders including diabetes, thyroid disorders, osteoporosis, growth hormone deficiency, cholesterol disorders, hypertension and obesity. Visit our site at www.aace.com.

About the American College of Endocrinology (ACE)

The American College of Endocrinology (ACE) is the educational and scientific arm of the American Association of Clinical Endocrinologists (AACE). ACE is the leader in advancing the care and prevention of endocrine and metabolic disorders by: providing professional education and reliable public health information; recognizing excellence in education, research and service; promoting clinical research and defining the future of Clinical Endocrinology. For more information, please visit www.aace.com/college.


American Association of Clinical Endocrinologists
Mary Green, 407-506-2960