Association Between Type 2 Diabetes Mellitus and Heart Failure: A Retrospective Study from a Tertiary Care Diabetes Centre in India

INTRODUCTION: The study aimed to explore the association between type 2 diabetes (T2D) and heart failure (HF) using echocardiography and NT-proBNP. The study also derived an NT-proBNP cut-off for diagnosing HF by echo in Asian Indians with T2D. METHODS: A retrospective study was performed using data from individuals with T2D, aged ≥ 18 years, who visited diabetes clinics in India between March 2019 and December 2023. NT-proBNP levels were quantified by chemiluminescence, and left ventricular ejection fraction (LVEF) was assessed from echo using two-dimensional (2D) echocardiography. Heart failure was classified based on the European Society of Cardiology (ESC) guidelines. Receiver operating characteristic (ROC) curve was performed to determine the optimal NT-proBNP cut-off for diagnosing HF by echo. RESULTS: Among the 1189 study individuals included in the study (714 men and 475 women), 5.9% were identified as having HF with reduced ejection fraction (HFrEF), 5.5% had mildly reduced ejection fraction (HFmrEF), and 14.1% had HF with preserved ejection fraction (HFpEF) while the rest (74.5%) had LVEF > 50%. Elevated NT-proBNP levels were observed in those with reduced ejection fraction. ROC analysis identified an optimal NT-proBNP threshold of 398 pg/mL for diagnosing HF, with 87% sensitivity and 78% specificity. HF prevalence increased with age, peaking at 30.6% in individuals aged 61-70 years. Women with HF had higher NT-proBNP levels than men. CONCLUSIONS: In this diabetes clinic population, 11.5% of individuals with T2D had moderate to reduced LVEF. Early identification of HF using echocardiography and NT-proBNP in a diabetes clinic could help improve prognosis.