Via practica 1/2005

CHRONIC HEART FAILURE AND DIABETES MELLITUS

Diabetes mellitus is one of the important risk factors of many cardiovascular diseases and its presence worsens the prognosis of particular disorder. There is 3–4 times greater incidence of diabetes mellitus in patients with heart failure than in those without it. The aetiology of heart failure in a diabetes mellitus doesn’t differ more significantly from the general population and the main reason is ischemic heart disease. Diabetic cardiomyopathy is a term describing the relationship between diabetes mellitus and heart disease, but it is probably not an independent unit. General principles of heart failure’s treatment are valid for a management of heart failure in patients with diabetes mellitus. The efficacy of ACE inhibitors has been comparable in the majority of studies in diabetics and non-diabetics, but thanks to increased mortality of diabetics the absolute number of saved lives is larger. Also the beta-blockers’ efficacy is comparable. The fundamental of treatment is an appropriate compensation of metabolic parameters, blood pressure, ACE inhibitors titration up to recommended doses and an optimal dose of beta-blocker. Patients with type 2 diabetes with and heart failure will need insulin more often than diabetics without it due to the impaired resorption and metabolism.

Keywords: diabetes mellitus, heart failure, prognosis, treatment.