DDG and DGK: A deadly interplay
by Michael Richter
(18.08.2022) Studies show that heart failure is present in almost a third of all diabetic patients. There is also a highly estimated number of unreported cases. Conversely, cardiac insufficiency is associated with a poor metabolic state: in corresponding studies, 30 to 40 percent of all heart patients already have prediabetes or manifest type 2 diabetes.
In order to draw more attention to the frequency and sometimes fatal interaction of these diseases, the German Diabetes Society (DDG) and the German Society for Cardiology (DGK) have published a first joint position paper. This is intended to sensitize physicians to the symptoms and draw attention to the need for those affected by both diseases to undergo regular examinations and receive interdisciplinary therapy.
“Diabetes mellitus and cardiac insufficiency go into a frequent, often underestimated and sometimes deadly interplay,” says Professor Dr. medical Thomas Forst, 1st Chairman of the “Diabetes & Heart” working group of the DDG. Mortality from cardiovascular events is increased by 50 to 90 percent. “It is all the more important to identify these high-risk patients at an early stage and to improve their life expectancy through differentiated therapy,” says the internist. The first joint position paper by the two specialist societies DDG and DGK summarizes the current scientific data on both clinical pictures in a compact manner. In addition, there are recommendations for treating diabetologists and cardiologists on what to consider in diagnosis and therapy.
Patients with diabetes mellitus are affected by heart failure up to five times more often than people with a healthy metabolism – even at a younger age. In addition, the so-called diastolic heart failure (HFpEF) is usually clinically inconspicuous. “It can therefore be assumed that the diagnosis of this form of heart failure in people with diabetes is far too rare and that there is a high number of unreported cases of those already affected,” explains the first author of the position paper, private lecturer Dr. medical Katharina Schütt, spokeswoman for the DGK working group “Heart and Diabetes”. “If the person concerned is symptomatic, such a dysfunction can be identified using echocardiography.”
Accordingly, the recommendation in the position paper is to regularly ask diabetic patients about the symptoms of heart failure. Conversely, heart failure patients have a significantly increased risk of developing type 2 diabetes mellitus. “Here, too, we urgently recommend regular diabetes screenings, in which the glucose and HbA1c value is measured and, if necessary, the OGTT is also determined,” Professor Dr. medical Dirk Müller-Wieland, spokesman for the interdisciplinary DDG committee “Heart, Diabetes & Hormones of the DDG, DGE & DGK”.
The close connection between heart failure and diabetes can be explained by an overall disturbance of the metabolism including the deterioration of the arterial and coronary condition. A permanently high long-term blood sugar value (HbA1c) increases chronic inflammatory processes in the vessels. The heart still pumps normally, but the vessel walls become stiff and the heart no longer fills with enough blood, which causes heart failure. Conversely, heart failure initiates diabetic processes that increase glucose metabolism and cause insulin resistance. “In the case of heart failure, every fifth person affected does not survive twelve months after being admitted to hospital for the first time. If it is recognized too late or underestimated, it often ends fatally,” says cardiologist Schütt.
In addition to diagnostic recommendations, the position paper also provides therapy advice. In heart failure, for example, SGLT-2 inhibitors are currently the preferred antidiabetic strategy. They prevent more frequent adverse cardiovascular events and associated hospitalizations and thus also reduce the risk of death. At the same time, they protect against kidney damage, which is also common in these patients. “In order to break the vicious circle between diabetes and heart failure, it is particularly important to keep the metabolism stable at an HbA1c value of 7 percent,” says Forst.
The new position paper is aimed at specialists in diabetology and cardiology and is now available to interested parties here: https://www.ddg.info/politik/stellungnahmen/positionspapier-herzinsuffizienz-und-diabetes
About the German Diabetes Society (DDG)
With more than 9,200 members, the German Diabetes Society (DDG) is one of the largest medical and scientific specialist societies in Germany. It supports science and research, is involved in further education and training, certifies treatment facilities and develops guidelines. The aim is more effective prevention and treatment of the widespread disease diabetes, which affects more than eight million people in Germany. To this end, it also undertakes extensive health policy activities.