Scottish scientists have suggested that patients with chronic heart failure (CHF) and type 2 diabetes should have their diabetes treated less aggressively, and that good blood sugar control could reduce their mortality risk.
Researchers at Dundee University aimed to investigate the importance of blood sugar control in patients with type 2 diabetes and CHF. To do this, they evaluated the records of 1,447 patients who met the study criteria.
Their records were monitored between 1993 and 2010, and researchers discovered an increased risk of premature death in patients whose blood glucose levels were outside of the HbA1c range of 7.1-8 per cent (54.1-63.9 mmol/mol).
It was also noted that this relationship was present in drug-treated patients, but not among those treated with diet alone. Patients on “low hypoglycemia risk” medication, such as metformin, had fewer outcomes than those treated with “high hypoglycemia risk” medication, such as insulin.
The researchers explained: “Reassuringly, we found patients on insulin sensitizers such as metformin to have a lower mortality risk than those who were not. This echoes previous findings by our group on the beneficial effects of metformin on a host of cardiovascular outcomes such as exercise capacity.”
Lead researcher Professor Chim Lang added: “We have already seen recent recommendations by the American Diabetes Association to treat elderly diabetic patients less aggressively. Our research suggests this advice should be extended to those patients who suffer with heart failure.”
The researchers concluded: “In patients with T2DM and CHF, our observational study shows that there is a U-shaped relationship between HbA1c and mortality, with the lowest mortality risk in patients with modest glycemic control (HbA1c = 7.1–8.0 per cent). We also demonstrated low hypoglycemia risk medications such as metformin to be safe and efficacious in this cohort.”
The Dundee University team have been awarded a grant by the European Foundation for the Study of Diabetes to commence the REFORM trial. The trial will study the cardiovascular effects of SGLT2 inhibitors – which are mainly used to treat type 2 diabetes patients – on patients with diabetes and heart failure.
“We are the first in the world to pioneer this research which could potentially see this drug treating both diabetes and heart failure simultaneously,” said Lang.
The findings were published in the European Journal of Heart Failure.

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