Diabetes and Heart Failure Outcomes

Chronic hyperglycaemia and insulin resistance substantially elevate the risk of heart failure, while heart failure itself predisposes to dysglycaemia and new-onset diabetes. Patients with diabetes are more likely to develop both heart failure with reduced ejection fraction and heart failure with preserved ejection fraction, presenting with higher rates of hospitalisation, adverse cardiac remodelling and mortality. Pathophysiological mechanisms include diabetic cardiomyopathy—characterised by myocardial fibrosis, microvascular rarefaction and metabolic inflexibility—and systemic factors such as hypertension, atherosclerosis and renal dysfunction. Conversely, heart failure induces neurohormonal activation, altered perfusion and inflammatory cascades that exacerbate insulin resistance and impair β-cell function. The global burden of co-existent diabetes and heart failure is rising, prompting integrated screening strategies, early intervention and multidisciplinary management. Recent advances in pharmacotherapy, notably sodium-glucose co-transporter 2 inhibitors and neurohormonal antagonists, have demonstrated dual benefits on glycaemic control and cardiovascular outcomes, reshaping clinical practice and reducing morbidity and mortality worldwide.

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Diabetes and Heart Failure Outcomes publication trend

The graph below shows the total number of articles in diabetes and heart failure outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Sodium-glucose co-transporter 2 inhibitors (SGLT2i): A class of glucose-lowering agents that block renal glucose reabsorption, improving glycaemic control and reducing cardiac and renal events.

Ejection fraction: The percentage of blood pumped out of the left ventricle with each heartbeat, used to classify heart failure as reduced (<40%) or preserved (≥50%).

Myocardial perfusion reserve (MPR): The ratio of myocardial blood flow during stress to that at rest, reflecting coronary microvascular function and used to detect microvascular dysfunction.

Insulin resistance: A metabolic state in which cells respond inadequately to normal levels of insulin, leading to elevated blood glucose and compensatory hyperinsulinaemia.

Diabetic cardiomyopathy: A distinct myocardial disorder in people with diabetes, characterised by structural and functional abnormalities independent of coronary artery disease and hypertension.

References

1. Sodium-glucose co-transporter 2 inhibitors and new-onset diabetes in cardiovascular or kidney disease. European Heart Journal (2024).
2. Evidence of a bi-directional relationship between heart failure and diabetes: a strategy for the detection of glucose abnormalities and diabetes prevention in patients with heart failure. Cardiovascular Diabetology (2024).
3. Occult coronary microvascular dysfunction and ischemic heart disease in patients with diabetes and heart failure. Journal of Cardiovascular Magnetic Resonance (2024).