Cardiac biomarkers-based screening in patients with diabetes mellitus at a population level

Background Individuals with diabetes mellitus are at high-risk of heart failure. Despite guideline recommendations, cardiac biomarker–based screening is not routinely performed in current clinical practice. We have developed the iDiabetes platform to enable protocolised, system-level testing embedded within routine diabetic care workflows. Purpose To determine the prevalence of elevated cardiac biomarkers and heart failure in a general diabetic population utilising the iDiabetes Platform. Methods We studied 4,341 patients with diabetes enrolled in the prospective, cluster-randomised iDiabetes trial conducted in primary care. NT-proBNP was measured during routine annual diabetes review, and high-sensitivity cardiac troponin I (hs-TnI) in patients aged ≥40 years. Echocardiography was performed where clinically indicated in those with elevated biomarkers. Associations between biomarkers were assessed using logistic regression. Results Among 4,194 patients without prior heart failure history (mean age 66 ± 13 years; 60% male; 91% with type 2 diabetes), median NT-proBNP was 92 ng/L (IQR 41–219), and median hs-TnI was 4 ng/L (IQR 2.5–7.2). NT-proBNP levels ≥125 ng/L were observed in 1,653 patients (38%), including 1,008 (23%) with 125–399 ng/L, 528 (12%) with 400–1,999 ng/L, and 117 (3%) with ≥2,000 ng/L. Elevated hs-TnI was observed in 109 (2.5%). Isolated NT-proBNP elevation occurred in 1561 (36%), whereas isolated hs-TnI elevation was present only in 29 patients (0.7%). 79 (2%) had both biomarkers elevated. NT-proBNP and hs-TnI were moderately correlated (Spearman’s rho = 0.492, 95% CI 0.468–0.515; p < 0.001). 315 patients (mean age 75 ± 9 years; 60% male; 90% with type 2 diabetes) underwent echocardiography. Mean LVEF was 55 ± 10%. New clinically significant echo findings were identified in 111 individuals (35%). 267 (85%) had LVEF >50%; 26 (8%) had LVEF 41-49%, and 22 (7%) had LVEF <=40%. Structural abnormalities were common, including left ventricular hypertrophy (LVH) in 101 (32%), left atrial (LA) dilatation in 87 (28%) and right atrial (RA) dilatation in 75 (24%). Other new cardiac diagnoses were made in 25 individuals (8%), including valvular heart disease in 19 (6%), atrial fibrillation in 4 (1.3%), LV thrombus in 1 (0.3%), and tricuspid valve mass in 1 (0.3%). 204 (65%) had no clinically significant echocardiographic abnormalities. Conclusions Integrating cardiac biomarker screening into routine diabetes care identified subclinical cardiac disease in a substantial proportion of individuals without known heart failure. Over one-third had an NT-proBNP≥125 ng/L, and among those undergoing echocardiography, one-third had new clinically significant cardiac findings. These findings highlight the feasibility and utility of routine biomarker testing to support early detection of heart failure and cardiovascular disease in patients with diabetes, potentially enabling earlier intervention and improved outcomes.