An American Diabetes Association (ADA) Consensus Report recognizing heart failure (HF) as an “underappreciated complication of diabetes” offers clinical guidance on optimal approaches for screening and diagnosis of HF in people with diabetes or prediabetes. The report, published June 1 in Diabetes Care included designated representation from the ACC.

Both Type 1 Diabetes (T1D) and Type 2 Diabetes (T2D) increase an individual’s risk of developing HF. Additionally, HF may be the first presentation of cardiovascular disease in many patients with diabetes. Despite these statistics, HF is frequently underdiagnosed. As such, the report, authored by Rodica Pop-Busui, MD, James L. Januzzi, MD, FACC, et al., aims to provide clinicians with algorithms and tools “at a time when choice of interventions is expected to be even more impactful, with requisite thoughtful clinical evaluation and involvement of multidisciplinary care.”

Key recommendations from the report include:

• Measurement of a natriuretic peptide or high-sensitivity cardiac troponin on at least a yearly basis to identify possible presence of stage B HF and to prognosticate risk for progression to symptomatic stages of the diagnosis.
• Implementation of individualized management regarding further testing and introduction or avoidance of treatments following abnormal natriuretic peptide or high-sensitivity cardiac troponin results. 
• Use of guideline-directed medical therapy (GDMT) similar to patients with HF and without diabetes, including am angiotensin receptor-neprilysin inhibitor (ARNI) (or ACEi/ARB if ARNI is not prescribed), evidence-based beta-blockers, mineralocorticoid receptor antagonists, and SGLT2i.
• Use of metformin, GLP1RA or insulin in individuals with T2D at high risk for/with established HF and for whom additional glycemic control is needed. 
• Consideration of diabetes technologies, cardiac rehabilitation programs and weight loss strategies as part of overall efforts to optimize care.
• Ensuring women, individuals with T1D, and those with high-burdened social determinants of health have access to and are offered the same management framework.

In addition to the recommendations, the authors identify several areas where knowledge gaps regarding epidemiology, mechanisms for HF risk, and care and management exist, and where future research could help inform the intersection of diabetes and HF. They also highlight potential opportunities to address equity, diversity and inclusion, whether through identifying sex-specific prevention and treatment approaches or determining how best to implement exercise programs that take into account “the entire spectrum of racially and socioeconomically diverse populations.”

"This important document emphasizes the importance of early recognition and thorough treatment of heart failure among individuals with diabetes,” said Januzzi, vice chair of the ADA Consensus Document and a member of the ACC Board of Trustees. “With more timely recognition of this high-risk diagnosis comes the opportunity to improve outcomes. The ACC is grateful for the opportunity to work collaboratively with the ADA to improve heart health for those with diabetes."

Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Heart Failure, Insulins, Troponin, Metformin, Algorithms, Receptors, Angiotensin, Angiotensin-Converting Enzyme Inhibitors, Diabetes Mellitus, Type 1, Prediabetic State, Diabetes Mellitus, Type 2, Neprilysin, Mineralocorticoid Receptor Antagonists, Angiotensin Receptor Antagonists

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