It was not too long ago that Diabetes and Heart failure were considered as two distinct entities. Both diseases have menacing, progressive, downhill and often fatal course but also not to mention innumerable complications associated with each of them. Although with the scourge of both diseases, there was matching and parallel evolution in modern medicine that has led to significant reductions in mortality and morbidity due to both ailments.
However for a very long time heart failure was studied separately from Diabetes Mellitus and both had diversely different drugs to treat the disorders. Gradually research accumulated providing evidence of overlap between the two diseases. It was seen that both may actually feed on each other. Heart failure emerged as the most frequent complication of Diabetes. A wealth of evidence has demonstrated that Diabetes Mellitus is independently associated with the risk of developing heart failure, with the hazard increasing by more than twofold in men and by more than fivefold in women.
Moreover at the same time the reverse also holds true as it was observed that in India around 50% of patients with long standing heart failure have Diabetes. Thus it was inferred that it would not be meaningful to treat both disorders separately. At the same time there had been dilemma in treatment of patients of Diabetes as it was shown that certain anti-diabetic drugs actually increase the propensity of developing heart failure and may actually be causing more harm than benefits. This had led to one of the most profound and path breaking declaration adopted by the concerned authorities that each anti diabetes drug must prove itself safe for the heart so as to be marketed and to be sold globally.
Overlap of the two disorders has also let the scientific community to adopt a new sub specialty namely ”Cardiodiabetology or cardiovascular endocrinology”. Thus the old school of thought of distinction between the two diseases had been blurred.
So, it is also understandably important to know that old and new therapies for both diseases may have to be mutually coordinated for safety and efficacy to be effective therapeutically.
What it means to patients?
- Enhanced vigilance is needed if one disease has been diagnosed. Early treatment would prevent fatalities as well complications.
- Tests for both diseases should be carried out periodically. It would help in knowing progression of the ailments so that appropriate measures are taken.
- Drugs for Diabetes should be evaluated for their adverse effects on Heart Failure as not all drugs are safe in such cases.
- Other risk factors for both disease such as smoking, lack of exercise, alcohol and unhealthy diet must be addressed.
- Newer scientific innovations would help in treatment of both disorders. Recently it was shown that Forxiga (Dapagliflozin) drug after the DAPA (HF) trial has shown to reduce cardiac as well total mortality in patients of heart failure.
- Science has proved that both Heart Failure and Diabetes are preventable disorders. We must adopt a disciplined lifestyle which should help us in avoiding this complex and deadly combination.
The Way Forward
Key to cardiodiabetology is a focus on enhanced collaboration and multidisciplinary approach to ensure that the lifestyle risk factors such as obesity, high blood pressure, lack of physical activity, smoking, alcoholism and poor dietary habits be addressed adequately. Therapeutic considerations must involve drugs effective and safe for both disease processes as well. This would be imperatives for optimizing quality of care so as to ensure the best possible outcomes in this complex disease process.