Perspective

Heart failure (HF) burden in people with type 2 diabetes (T2D) HF is a frequent condition occurring in patients with diabetes (DM) (1,2). Diabetic men and women display a 6 to 8-fold increase in the prevalence of HF, with the highest number of cases observed in the latter group (3). Among patients with HF, 15-26 % has DM, a condition which amplifies morbidity and mortality (4-6). The recent ATLAS study showed that the proportion of DM patients with HF may reach 20 % (7). HF patients with concomitant DM have a further increase in morbidity and mortality due to coexistence of several mechanisms including disturbed neurohormonal axis as well as structural and functional abnormalities occurring in the diabetic myocardium (8). About one fifth of patients with chronic HF has DM, and such prevalence reaches 40 % for patients with worsening HF (5). T2D individuals are at increased risk for both HF with preserved (HFPEF) and reduced (HFREF) ejection fraction (9). Notably, prospective analyses have shown that the prognosis of HFPEF is comparable to the one reported for HFREF patients, with a 50-60 % mortality rate after 5 years (10). Recent data show that diabetic HFPEF patients display increased HF hospitalization or HF death as compared to non-DM subjects (30.9 % vs. 19.0%, respectively), with an estimated 68 % increased risk after adjusting for relevant confounders (adjusted HR, 1.68; 95 % CI: 1.26-2.25, P<0.001) (11). Another important aspect to be considered is that the prognosis of DM patients with HF remains worse even though thes