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*It is only for medical professionals to read for reference.
There are many complications of diabetes, which make patients move to different departments.
Among them, heart failure ranks second in the cardiovascular complications of diabetes.
Quiz: (read the full text, see the answer at the end of the article) Heart failure (heart failure) is a serious and terminal stage of cardiovascular disease (CVD), with a high disability and mortality rate.
As the population ages, the prevalence of heart failure is also increasing, and it has gradually become an important global public health problem1.
According to data in 2019, the prevalence of heart failure among residents over 35 years old in my country is 1.
3%, and the number of patients is about 8.
9 million2.
Heart failure is the final result of various cardiovascular events and the cumulative effect of various cardiac abnormalities.
The overall prognosis is poor, with high mortality and hospitalization rates1.
Studies have shown that the 30-day, 1-year, and 5-year mortality rates of hospitalized patients with heart failure are 10.
4%, 22%, and 42.
3%, respectively.
The 5-year survival rate of patients with heart failure is even comparable to some malignant tumors.
The 1-year rehospitalization rates of hospitalized patients with heart failure and stable heart failure reached 44% and 32%, respectively3.
Heart failure seriously affects the quality of life of patients and brings a huge social burden.
Heart failure "hands in hand" with diabetes, the common cause of evil requires timely intervention.
Heart failure and diabetes are risk factors for each other.
The vicious circle aggravates the disease.
Heart failure is a risk factor for diabetes, and diabetes is also a risk factor for heart failure.
The two are closely related and mutually promote.
, Forming a vicious circle.
Through a survey of more than 4.
5 million type 2 diabetes (T2DM) patients worldwide, it was found that the incidence of heart failure among T2DM patients was 14.
9%.
Moreover, compared with non-diabetic people, the risk of heart failure in men with T2DM is increased by two times, and the risk of heart failure in women with T2DM is increased by five times4.
On the other hand, about 35%-45% of patients with chronic heart failure have T2DM, and more than 40% of T2DM patients are repeatedly hospitalized due to worsening heart failure4.
It can be said that T2DM and heart failure affect each other.
Exacerbate the disease.
The risk of heart failure is related to glycosylated hemoglobin (HbA1c), and timely and effective sugar control is necessary.
Other studies have shown that the risk of heart failure is related to HbA1c.
The results of the study show that if HbA1c is higher than 5.
5% in non-diabetic patients, the risk of heart failure will also increase.
For every 1% increase in HbA1c, the risk of heart failure increases by 39%.
In T2DM patients, every 1% increase in HbA1c results in heart failure.
The risk will increase by 8% to 16%4.
Therefore, for diabetic patients with heart failure, it is necessary to reduce blood sugar in a timely and effective manner to control the risk of heart failure.
In 2019, the "Guidelines for Diabetes, Prediabetes and Cardiovascular Diseases" jointly launched by the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD) also emphasized strengthening blood glucose management in the early stages of diabetes to improve patients' cardiovascular outcomes5.
How should hypoglycemic treatment be carried out for such patients? It is recommended to lower blood sugar for patients with heart failure that basic insulin therapy can be used to control blood sugar in diabetic patients with heart failure.
When formulating a hypoglycemic plan, attention should be paid to the potential adverse effects of hypoglycemic drugs on heart failure, and a drug treatment that takes into account both efficacy and safety should be selected.
Many guidelines have proposed that diabetics with heart failure can use basal insulin.
The "2019 ESC/EASD Guidelines for Diabetes, Prediabetes and Cardiovascular Diseases" pointed out that for diabetic patients who need to reduce the risk of heart failure, saxagliptin and thiazolidine Diketone (TZD) drugs are not recommended, and patients may consider insulin5.
The "2021 Diabetes Medical Diagnosis and Treatment Standards" formulated by the American Diabetes Association (ADA) also proposes that for such patients, sodium-glucose cotransporter-2 inhibitors (SGLT-2i) or glucagon with clear CVD benefits should be used GLP-1 receptor agonists are still not up to standard, and basal insulin can be added6.
The latest "2020 Chinese Type 2 Diabetes Prevention Guidelines" released at the 24th National Academic Conference of the Diabetes Branch of the Chinese Medical Association (CDS) pointed out that for diabetic patients with heart failure, when SGLT-2i treatment is still not up to standard, Drugs other than TZD should be used, and when insulin is used, basal insulin is usually used (Figure 1)7.
Figure 1 Evidence-based assistance in the diagnosis and treatment path of various T2DM patients, with excellent glucose control effect of basal insulin.
Among the common basic insulins in clinical practice, a new generation of long-acting insulin analogues have attracted much attention, such as insulin glargine U300, which can be obtained through a number of clinical trials.
See its excellent sugar control effect.
The EDITION Asian population study is an open-label, randomized controlled study that included 604 patients with T2DM who had not used insulin.
After 26 weeks of treatment, insulin glargine U300 significantly improved patients’ HbA1c by 1.
6%, compared with insulin glargine U100 Equivalent (Figure 2) 8.
Figure 2 Insulin glargine U300 and insulin glargine U100 have similar hypoglycemic levels.
A head-to-head randomized controlled study of insulin glargine U300 and insulin degluargine-In the BRIGHT study, 929 patients with T2DM who had not used insulin were included in 24 After Zhou's treatment, it was found that the HbA1c of patients treated with insulin glargine U300 decreased by 1.
64%, which was equivalent to that of insulin degludec (Figure 3)9.
Figure 3 Insulin glargine U300 and insulin degludec reduce the risk of hypoglycemia by the same degree.
Only patients with heart failure and diabetes can control their sugar with peace of mind.
Severe hypoglycemia is related to the risk of cardiovascular disease and the increase in total mortality in patients in the future.
Diabetes patients with heart failure should try to prevent hypoglycemia while controlling blood sugar.
In particular, the incidence and prevalence of heart failure patients increase with age, and elderly patients account for a relatively high proportion.
Studies have shown that the prevalence of heart failure in people over 80 years old can be close to 12%, so we need to be more vigilant.
The occurrence of hypoglycemia11.
In the "2021 Chinese Guidelines for Diagnosis and Treatment of Diabetes in the Elderly", it is also recommended to choose several basal insulins, including insulin glargine U300, for elderly patients treated with insulin.
The blood concentration is stable and the risk of hypoglycemia is low12. A large amount of evidence-based evidence shows that compared with other insulin treatments, insulin glargine U300 has a lower risk of hypoglycemia, so it is a safe choice for diabetes patients with heart failure.
A meta-analysis showed that compared with premixed insulin and neutrophil insulin (NPH), patients treated with insulin glargine U300 had a significantly lower rate of nighttime hypoglycemia events (Figure 4)13.
Figure 4 Compared with premixed insulin and NPH, insulin glargine U300 has a lower risk of hypoglycemia.
Data in the BRIGHT study also showed that, 12 weeks before treatment, that is, the initial dose adjustment period, insulin glargine is used compared to insulin deglu In patients treated with U300, the rate of hypoglycemia events was significantly reduced by 43% (Figure 5)8.
Figure 5 Compared with insulin glargine and insulin glargine U300, the risk of hypoglycemia is lower.
Conclusion Heart failure is the final result of various cardiovascular events and the cumulative effect of various cardiac abnormalities.
It has a poor prognosis and a high risk of death.
It is a mutual influencing factor with diabetes.
, The two interact, a vicious circle.
Therefore, it is necessary to control blood sugar in a timely and effective manner to reduce the risk of heart failure.
According to multiple guidelines, diabetics with heart failure can use basal insulin.
Insulin glargine U300 achieves excellent blood sugar control, and the risk of hypoglycemia is lower than that of similar insulins.
It is an ideal hypoglycemic drug choice for such patients. Quiz answer: B.
Have you chosen the right method of diabetes treatment that can adjust the risk of heart failure outcome? References: 1.
Chinese Medical Doctor Association Cardiovascular Physician Branch, etc.
Chinese Journal of Circulation.
2020;35(12):1166-1180.
2.
Guang Hao, et al.
Eur J Heart Fail.
2019; 21(11): 1329 -1337.
3.
National Health and Family Planning Commission of the Expert Committee on Rational Use of Medicines.
Chinese Journal of Medical Frontiers (Electronic Edition).
2019; 11(7).
4.
Ali A, et al.
Diabetes Ther.
2019; 10(5): 1595-1622.
5.
Cosentino F, et al.
Eur Heart J.
2020; 41(2): 255-323.
6.
American Diabetes Association.
Diabetes Care.
2021; 44(Suppl 1): S111-S124.
7.
http://www.
cpcd.
org.
cn/news/xingyezixun/2020/1128/5285.
html8.
Ji L, et al.
Diabetes Obes Metab.
2020; 22(4): 612-621.
9.
Julio Rosenstock, et al.
Diabetes Care.
2018; 41(10): 2147-2154.
10.
Echouffo-Tcheugui JB, et al.
Diabetes Care.
2021; 44(1): 248-254.
11.
Roger VL, et al.
Circulation.
2012; 125(1): 188.
12.
National Center for Geriatrics, et al.
Chinese Journal of Diabetes.
2021; 13(1): 14-46.
13.
Freemantle N, et al.
BMJ Open.
2016; 6(2): e009421.
This information is for medical and scientific reference only , Sanofi does not recommend using this product in any way that is inconsistent with the prescription information approved in your country.
There are many complications of diabetes, which make patients move to different departments.
Among them, heart failure ranks second in the cardiovascular complications of diabetes.
Quiz: (read the full text, see the answer at the end of the article) Heart failure (heart failure) is a serious and terminal stage of cardiovascular disease (CVD), with a high disability and mortality rate.
As the population ages, the prevalence of heart failure is also increasing, and it has gradually become an important global public health problem1.
According to data in 2019, the prevalence of heart failure among residents over 35 years old in my country is 1.
3%, and the number of patients is about 8.
9 million2.
Heart failure is the final result of various cardiovascular events and the cumulative effect of various cardiac abnormalities.
The overall prognosis is poor, with high mortality and hospitalization rates1.
Studies have shown that the 30-day, 1-year, and 5-year mortality rates of hospitalized patients with heart failure are 10.
4%, 22%, and 42.
3%, respectively.
The 5-year survival rate of patients with heart failure is even comparable to some malignant tumors.
The 1-year rehospitalization rates of hospitalized patients with heart failure and stable heart failure reached 44% and 32%, respectively3.
Heart failure seriously affects the quality of life of patients and brings a huge social burden.
Heart failure "hands in hand" with diabetes, the common cause of evil requires timely intervention.
Heart failure and diabetes are risk factors for each other.
The vicious circle aggravates the disease.
Heart failure is a risk factor for diabetes, and diabetes is also a risk factor for heart failure.
The two are closely related and mutually promote.
, Forming a vicious circle.
Through a survey of more than 4.
5 million type 2 diabetes (T2DM) patients worldwide, it was found that the incidence of heart failure among T2DM patients was 14.
9%.
Moreover, compared with non-diabetic people, the risk of heart failure in men with T2DM is increased by two times, and the risk of heart failure in women with T2DM is increased by five times4.
On the other hand, about 35%-45% of patients with chronic heart failure have T2DM, and more than 40% of T2DM patients are repeatedly hospitalized due to worsening heart failure4.
It can be said that T2DM and heart failure affect each other.
Exacerbate the disease.
The risk of heart failure is related to glycosylated hemoglobin (HbA1c), and timely and effective sugar control is necessary.
Other studies have shown that the risk of heart failure is related to HbA1c.
The results of the study show that if HbA1c is higher than 5.
5% in non-diabetic patients, the risk of heart failure will also increase.
For every 1% increase in HbA1c, the risk of heart failure increases by 39%.
In T2DM patients, every 1% increase in HbA1c results in heart failure.
The risk will increase by 8% to 16%4.
Therefore, for diabetic patients with heart failure, it is necessary to reduce blood sugar in a timely and effective manner to control the risk of heart failure.
In 2019, the "Guidelines for Diabetes, Prediabetes and Cardiovascular Diseases" jointly launched by the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD) also emphasized strengthening blood glucose management in the early stages of diabetes to improve patients' cardiovascular outcomes5.
How should hypoglycemic treatment be carried out for such patients? It is recommended to lower blood sugar for patients with heart failure that basic insulin therapy can be used to control blood sugar in diabetic patients with heart failure.
When formulating a hypoglycemic plan, attention should be paid to the potential adverse effects of hypoglycemic drugs on heart failure, and a drug treatment that takes into account both efficacy and safety should be selected.
Many guidelines have proposed that diabetics with heart failure can use basal insulin.
The "2019 ESC/EASD Guidelines for Diabetes, Prediabetes and Cardiovascular Diseases" pointed out that for diabetic patients who need to reduce the risk of heart failure, saxagliptin and thiazolidine Diketone (TZD) drugs are not recommended, and patients may consider insulin5.
The "2021 Diabetes Medical Diagnosis and Treatment Standards" formulated by the American Diabetes Association (ADA) also proposes that for such patients, sodium-glucose cotransporter-2 inhibitors (SGLT-2i) or glucagon with clear CVD benefits should be used GLP-1 receptor agonists are still not up to standard, and basal insulin can be added6.
The latest "2020 Chinese Type 2 Diabetes Prevention Guidelines" released at the 24th National Academic Conference of the Diabetes Branch of the Chinese Medical Association (CDS) pointed out that for diabetic patients with heart failure, when SGLT-2i treatment is still not up to standard, Drugs other than TZD should be used, and when insulin is used, basal insulin is usually used (Figure 1)7.
Figure 1 Evidence-based assistance in the diagnosis and treatment path of various T2DM patients, with excellent glucose control effect of basal insulin.
Among the common basic insulins in clinical practice, a new generation of long-acting insulin analogues have attracted much attention, such as insulin glargine U300, which can be obtained through a number of clinical trials.
See its excellent sugar control effect.
The EDITION Asian population study is an open-label, randomized controlled study that included 604 patients with T2DM who had not used insulin.
After 26 weeks of treatment, insulin glargine U300 significantly improved patients’ HbA1c by 1.
6%, compared with insulin glargine U100 Equivalent (Figure 2) 8.
Figure 2 Insulin glargine U300 and insulin glargine U100 have similar hypoglycemic levels.
A head-to-head randomized controlled study of insulin glargine U300 and insulin degluargine-In the BRIGHT study, 929 patients with T2DM who had not used insulin were included in 24 After Zhou's treatment, it was found that the HbA1c of patients treated with insulin glargine U300 decreased by 1.
64%, which was equivalent to that of insulin degludec (Figure 3)9.
Figure 3 Insulin glargine U300 and insulin degludec reduce the risk of hypoglycemia by the same degree.
Only patients with heart failure and diabetes can control their sugar with peace of mind.
Severe hypoglycemia is related to the risk of cardiovascular disease and the increase in total mortality in patients in the future.
Diabetes patients with heart failure should try to prevent hypoglycemia while controlling blood sugar.
In particular, the incidence and prevalence of heart failure patients increase with age, and elderly patients account for a relatively high proportion.
Studies have shown that the prevalence of heart failure in people over 80 years old can be close to 12%, so we need to be more vigilant.
The occurrence of hypoglycemia11.
In the "2021 Chinese Guidelines for Diagnosis and Treatment of Diabetes in the Elderly", it is also recommended to choose several basal insulins, including insulin glargine U300, for elderly patients treated with insulin.
The blood concentration is stable and the risk of hypoglycemia is low12. A large amount of evidence-based evidence shows that compared with other insulin treatments, insulin glargine U300 has a lower risk of hypoglycemia, so it is a safe choice for diabetes patients with heart failure.
A meta-analysis showed that compared with premixed insulin and neutrophil insulin (NPH), patients treated with insulin glargine U300 had a significantly lower rate of nighttime hypoglycemia events (Figure 4)13.
Figure 4 Compared with premixed insulin and NPH, insulin glargine U300 has a lower risk of hypoglycemia.
Data in the BRIGHT study also showed that, 12 weeks before treatment, that is, the initial dose adjustment period, insulin glargine is used compared to insulin deglu In patients treated with U300, the rate of hypoglycemia events was significantly reduced by 43% (Figure 5)8.
Figure 5 Compared with insulin glargine and insulin glargine U300, the risk of hypoglycemia is lower.
Conclusion Heart failure is the final result of various cardiovascular events and the cumulative effect of various cardiac abnormalities.
It has a poor prognosis and a high risk of death.
It is a mutual influencing factor with diabetes.
, The two interact, a vicious circle.
Therefore, it is necessary to control blood sugar in a timely and effective manner to reduce the risk of heart failure.
According to multiple guidelines, diabetics with heart failure can use basal insulin.
Insulin glargine U300 achieves excellent blood sugar control, and the risk of hypoglycemia is lower than that of similar insulins.
It is an ideal hypoglycemic drug choice for such patients. Quiz answer: B.
Have you chosen the right method of diabetes treatment that can adjust the risk of heart failure outcome? References: 1.
Chinese Medical Doctor Association Cardiovascular Physician Branch, etc.
Chinese Journal of Circulation.
2020;35(12):1166-1180.
2.
Guang Hao, et al.
Eur J Heart Fail.
2019; 21(11): 1329 -1337.
3.
National Health and Family Planning Commission of the Expert Committee on Rational Use of Medicines.
Chinese Journal of Medical Frontiers (Electronic Edition).
2019; 11(7).
4.
Ali A, et al.
Diabetes Ther.
2019; 10(5): 1595-1622.
5.
Cosentino F, et al.
Eur Heart J.
2020; 41(2): 255-323.
6.
American Diabetes Association.
Diabetes Care.
2021; 44(Suppl 1): S111-S124.
7.
http://www.
cpcd.
org.
cn/news/xingyezixun/2020/1128/5285.
html8.
Ji L, et al.
Diabetes Obes Metab.
2020; 22(4): 612-621.
9.
Julio Rosenstock, et al.
Diabetes Care.
2018; 41(10): 2147-2154.
10.
Echouffo-Tcheugui JB, et al.
Diabetes Care.
2021; 44(1): 248-254.
11.
Roger VL, et al.
Circulation.
2012; 125(1): 188.
12.
National Center for Geriatrics, et al.
Chinese Journal of Diabetes.
2021; 13(1): 14-46.
13.
Freemantle N, et al.
BMJ Open.
2016; 6(2): e009421.
This information is for medical and scientific reference only , Sanofi does not recommend using this product in any way that is inconsistent with the prescription information approved in your country.
