Insuffisance cardiaque et diabète : la nouvelle épidémie sous-estimée, mal connue, qui ne peut être ignorée plus longtemps

Diabetologists for the most of us, especially discovered heart failure (HF) and its importance in diabetics as a result of the data from the EMPA-REG OUTCOME study. The numerous cardiovascular safety studies, which have been requested for the new antidiabetic drugs by the FDA since 2008, already bringing together 150,000 type 2 diabetics (T2Ds), have not so far specified HF (but in some, hospitalizations for HF), as one of the objectives, being limited to MACE-3 points. However, it was found that 10 to 25% of T2D patients at entry into these studies were suffering of HF, which was not systematically sought. Many studies have found that the frequency of HF is actually higher than expected and often underdiagnosed. Actually, we can affirm that this complication will be one of the major medical issues of diabetes in the coming years, and subsequently this complication must be better known by diabetologists. Briefly what we know at present? HF pathophysiology is not univocal (at least myocardial ischemia and specific cardiomyopathy), its ultrasound (echocardiography) diagnosis can be difficult, its biological screening insufficiently practiced by our specialty, its prognosis worse than in the absence of diabetes, its costs considerable. Its treatment is fairly well codified and has been recently enriched by the specific effects of SGLT2 inhibitors (gliflozins) demonstrated in major randomized placebo-controlled outcome trials and in real-life using these drugs. Finally, the major cardiovascular safety studies of antidiabetics must specifically include HF as a major goal in addition to MACE-3 points.