Dysglycemia and Heart Failure: Complex and Challenging Medley

The cardiovascular complications of type 2 diabetes (T2DM) are contributing considerably to morbidity and mortality worldwide, heart failure (HF) being one of the most frequent. The adverse effect of T2DM on myocardium can develop early, and is clinically presenting as left ventricular (LV) diastolic dysfunction in the absence of other heart disease to micro and macrovascular complications leading to severe forms of systolic dysfunction and terminal heart falilure. Therfore, clinical presentation can vary from asymptomatic or mild to severe heart failure symtoms. The prevalence of LV dysfunction in T2DM demonstrate the wide variations caused by diverse patient selection and heterogenous criteria for its diagnosis. Patient selection varies in terms of age, duration, stage and microvascular complications of T2DM. Several clinical correlates were reported such as: age, duration of T2DM, parameters of glycoregulation, insulin resistance and renal function. It is important that the treatment should be initiated as early as possbile. Various therapeutic options include improving diabetic control with diet, daily physical activity and reduction in body mass index. Both antiglycaemic and cardiovascular drugs should be used to improve LV function. Improved glucose control substantially reduces the risk of microvascular complications and, with extended follow-up, modestly reduces the risk of atherosclerotic events. Large-scale trials of new glucose-lowering drugs on hospital admission for heart failure give promising perspective.