Around 8.5 million people in Germany between the ages of 18 and 79 have type 2 diabetes mellitus (T2D) [1]. When these patients visit a doctor’s surgery, either for a check-up or because they have symptoms, a number of values are usually checked: weight, blood glucose, blood pressure and HbA1c levels. But this is often not enough. In the opinion of doctors, people with diabetes should be viewed less glucocentrically and should also be seen as high-risk cardiovascular patients. One disease in particular should be given greater attention: heart failure (HF).

Relationship between HI and T2D

Epidemiological studies have long suggested a link between T2D and HI. In fact, it is now known that people with diabetes have a significantly increased risk of developing HI [2, 3]. The incidence of HI in diabetes patients rises sharply from the age of 50 – much earlier than in non-diabetics [2]. This is because the metabolic disease leads to tissue remodeling and arrhythmia, limits the performance of the pumping organ and damages the heart in the long term.

The simultaneous occurrence of HI and T2D significantly worsens the prognosis of those affected. The diseases occur together relatively frequently [4], and those affected die earlier on average [5]. A late diagnosis of HI also has negative consequences for those affected, for example leading to more frequent hospital stays [6]. Although there is a short-term improvement when patients are hospitalized for acute heart failure, each acute event also contributes to a progressive decline in cardiac function.

Often unclear symptoms

It is important for doctors to recognize the possible presence of heart failure in their diabetic patients at an early stage: Palpitations, shortness of breath, ankle edema, but also reduced performance, rapid fatigue and tiredness can indicate a heart that is no longer able to perform [7]. However, HI caused by diabetes is difficult to diagnose, especially in the early stages. The symptoms can be mild, non-persistent or non-specific. In addition, symptoms such as tiredness and fatigue can be caused by overexertion, while shortness of breath can also be induced by obesity, for example. Not every doctor may immediately think that HI could be behind such symptoms.

Safely rule out HI with NT-proBNP

However, anyone who suspects that their patients have heart failure can obtain certainty: If HI is suspected, a special laboratory test allows a reliable exclusion and supports the identification of patients with an increased risk of such a disease. This is because people whose heart is no longer pumping adequately have an increased NT-proBNP level (N-terminal pro B-type natriuretic peptide). A plasma concentration of NT-proBNP < 125 pg/ml makes the diagnosis of HI unlikely [4, 11-13]. Higher values should be clarified by echocardiography.

NT-proBNP measurement is also an important tool because it can be performed quickly and easily in the doctor’s office – especially when a timely appointment at the cardiologist’s office, such as in rural areas, is rather difficult to obtain. NT-proBNP is also a strong predictive marker for the risk of cardiovascular death in T2D patients: The higher the NT-proBNP value, the worse the prognosis [14].

SGLT2i treatment delays hospitalization and death

The safe and early detection of HI is also relevant because a wide range of treatment options are available today. Current treatment recommendations focus primarily on the so-called SGLT2 inhibitors: originally developed and introduced as oral antidiabetics, the active ingredients block the body’s own protein SGLT2 (sodium-glucose linked transporter 2) [16]. As a result, they promote glucose excretion via the urine and thus lower blood sugar levels. People with T2D therefore benefit in several ways – this is also confirmed by outcome-based studies: they showed that both hospitalization and death could be delayed in patients with diabetes and increased cardiovascular risk with SGLT2i treatment [16].

Increasing importance of NT-proBNP

In fact, the importance of NT-proBNP has already been recognized by the specialist disciplines in Germany: In their joint position paper, the German Society of Cardiology and the German Diabetes Society recommend the test for T2D patients, for signs and symptoms of HI and for those affected by risk factors [3]. This is more than good news for patient safety.

Further information is also available at www.roche.de/diabetesundherzinsuffizienz available.

The article was published at aerzteblatt.de on 23.09.2024 Literature

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