Understanding the relationship between Heart Failure and Diabetes

Cardiovascular diseases (CVDs) or heart diseases are the most prevalent non-communicable diseases (NCDs), in India ¹. Demographic transitions and lifestyle factors like tobacco use, unhealthy diet, physical inactivity and psycho-social stress, can be largely attributed to the increased prevalence of heart-related ailments in India.
Recent studies indicate a strong correlation between Heart Failure (HF) – a progressive heart disease – and other chronic diseases like Type 2 diabetes. These co-existing conditions can lead to increased hospitalization in Heart Failure patients, if not diagnosed and managed on time. ²

Diabetes and Heart Failure

Type 2 diabetes and Heart Failure (HF) commonly coexist, with diabetes occurring in 25% of patients with chronic Heart Failure and 40% in those hospitalized with acute Heart Failure (severe stage). Heart Failure patients with diabetes have increased hospitalization rate compared to patients without diabetes. ³

On the other hand, multiple prior studies indicate that diabetes increases the risk for the development of Heart Failure ^{4 5 6}, due to diabetic cardiomyopathy. It is a disorder of the heart muscle in diabetic patients, due to which the heart is unable to circulate blood properly, across the body. Clinical observations show that the treatment of diabetes tends to mask the symptoms of heart diseases. Hence identification and management of diabetes is essential to avoid worsening of Heart Failure ⁷.

It is important for diabetes patients to pay close attention to the following symptoms:

Swelling in the ankles, legs and abdomen

Fluid build-up might cause swelling in ankles, legs and abdomen. This is one of the key symptoms of Heart Failure. Diabetics should be extra careful to not confuse the swelling in ankles or legs, as a result of diabetes.

Constant tiredness and Fatigue

Fatigue is one of the most common problems associated with poorly controlled blood sugar⁸. It is also an important symptom of Heart Failure. Given that the heart is unable to pump blood properly, the body becomes devoid of oxygen and nutrients because of which patients tend to experience fatigue.

Uncontrolled Glucose levels

Nearly 1 in 7 patients with diabetes have poor glycemic control ⁹, which is a strong risk factor for hospitalization of Heart Failure patients with Type 2 diabetes.

Shortness of Breath

Diabetics often miss a very important symptom of Heart Failure – shortness of breath, caused due to fluid retention in the lungs. They tend to confuse it as a symptom of low levels of insulin in the body and delay seeking medical advice. ¹⁰

Heart Failure in diabetes patients can be effectively managed with timely diagnosis, regular screening of the blood sugar levels and lifestyle modifications.

Often after a certain duration of receiving treatment, patients tend to discontinue medication as symptoms start getting better, which can lead to further worsening of the condition. Therefore, adherence to treatment is a must for patients.

The Times of India in partnership with Novartis has launched #BeatHeartFailure- an initiative to raise awareness around heart failure. Give a missed call on 9025 100 600 or visit www.toibeatheartfailure.com to take the Heart Failure Symptom Checker.

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References

1. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30448-0/fulltext
2. https://www.ahajournals.org/doi/pdf/10.1161/CIRCHEARTFAILURE.116.003316
3. Dei Cas A, Khan SS, Butler J, Mentz RJ, Bonow RO, Avogaro A, Tschoepe D, Doehner W, Greene SJ, Senni M, Gheorghiade M, Fonarow GC. Impact of diabetes on epidemiology, treatment, and outcomes of patients with heart failure. JACC Heart Fail. 2015;3:136–145. doi: 10.1016/j.jchf.2014.08.004
4. Nichols GA, Gullion CM, Koro CE, Ephross SA, Brown JB. The incidence of congestive heart failure in type 2 diabetes: an update. Diabetes Care. 2004;27:1879–1884
5. Lewis EF, Moye LA, Rouleau JL, Sacks FM, Arnold JM, Warnica JW, Flaker GC, Braunwald E, Pfeffer MA. Predictors of late development of heart failure in stable survivors of myocardial infarction: the CARE study. J Am Coll Cardiol. 2003;42:1446–1453
6. Kannel WB, McGee DL. Diabetes and cardiovascular disease. The Framingham study. JAMA. 1979;241:2035–2038
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2803107/
8. https://www.everydayhealth.com/type-2-diabetes/why-does-type-2-diabetes-make-you-feel-tired/
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4633198/ https://www.healio.com/endocrinology/diabetes/news/print/endocrine-today/%7Bf0d325a2-3d4b-4241-aae9-f9fff1576011%7D/poor-glycemic-control-heart-failure-link-strong-in-patients-with-type-2-diabetes
10. https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-20371551