Mechanisms and treatment of heart failure in diabetes

Heart failure is an increasingly common cause of cardiovascular morbidity and mortality in people with diabetes. The pathophysiology of heart failure in diabetes includes factors related to coronary heart disease, with myocardial ischaemia and myocardial scarring following myocardial infarction. Non‐ischaemic mechanisms are also important, including structural, metabolic, and biochemical abnormalities. Treatment of heart failure in people with diabetes is in essence the same as for other patients, along with optimised diabetic control. ACE inhibitors and beta blockers should be commenced in all patients with a diagnosis of heart failure with reduced ejection fraction regardless of NYHA class. Aldosterone antagonists, cardiac resynchronisation therapy and heart transplantation all have a role in management of patients of NYHA class III and IV. In patients with heart failure with preserved ejection fraction, which is more common in people with diabetes, there is unfortunately no evidence of benefit for these therapies and a diuretic‐based regimen is used to alleviate symptoms