Increasing severity of HF was associated with greater risk for the development of diabetes in a new study.
However, researchers found that use of renin-angiotensin system inhibitors may attenuate the risk for diabetes.
A previous study by the same research team demonstrated an increased risk for diabetes in patients with HF after MI. The new study was performed to analyze the risk for diabetes among all patients with HF, regardless of MI.
Malene N. Demant, MD, from Copenhagen University Hospital Gentofte in Denmark, and colleagues followed all Danish patients discharged from first-time hospitalization for HF between 1997 and 2010 who had not previously used hypoglycemic agents (n=99,362). They estimated severity of HF by loop-diuretic dosage 90 days after discharge. Patients were stratified into five dosage groups: no loop diuretics (31%); ≤40 mg/day (25%); >40 mg/day to 80 mg/day (17%); >80 mg/day to 159 mg/day (12%); and ≥160 mg/day (15%).
Follow-up occurred until a claimed prescription for an oral diabetes drug, death or the end of 2010.
During follow-up, 8% of all patients developed diabetes and 63% of all patients died.
Loop-diuretic dosage was associated with increased risk for developing diabetes in a dose-dependent manner. The researchers also reported that use of renin-angiotensin system inhibitors attenuated the risk for developing diabetes (P<.0001).
Compared with patients using no loop diuretics, the adjusted HRs for other patients were as follows:
- Patients taking ≤40 mg/day: HR=1.16 (95% CI, 1.07-1.26) with use of renin-angiotensin system inhibitors; HR=2.06 (95% CI, 1.83-2.32) without.
- Patients taking >40 mg/day to 80 mg/day: HR=1.35 (95% CI, 1.24-1.46) with use of renin-angiotensin system inhibitors; HR=2.28 (95% CI, 2.01-2.59) without.
- Patients taking >80 mg/day to 159 mg/day: HR=1.48 (95% CI, 1.35-1.62) with use of renin-angiotensin system inhibitors; HR=2.88 (95% CI, 2.52-3.3) without.
- Patients taking ≥160 mg/day: HR=1.76 (95% CI, 1.61-1.92) with use of renin-angiotensin system inhibitors; HR=3.02 (95% CI, 2.66-3.43) without.
“It might be that the sickest patients are those who develop diabetes,” Demant said in a press release. “Thus, diabetes may, in part, be a marker of [HF] severity in addition to being a causal risk factor for mortality in [HF] cohorts.”
Disclosure: Two researchers report financial ties with Novo Nordisk A/S.