Treatment of diabetes and heart failure: joint forces

This editorial refers to ‘Heart failure outcomes with empagliflozin in patients with type 2 diabetes at high cardiovascular risk: results of the EMPA-REG OUTCOME® trial’†, by D. Fitchett et al. on page 1526. People with type 2 diabetes mellitus (T2DM) are at increased risk of future cardiovascular disease, and chronic heart failure (CHF) is an important complication and cause of mortality. It has been estimated that the proportion of CHF patients with known T2DM is 20–35%.1 A Swedish registry report confirms that 25% of patients diagnosed with CHF in all day practice have previously known T2DM, a majority of ischaemic origin.2 The true proportion is probably considerably higher since undiagnosed T2DM is common, not least in populations with cardiovascular diseases.3 Further, in the population, a diagnosis of CHF is twice as common among patients with than among those without T2DM.4 The combination of T2DM and HF is expected to rise in the future, partly due to the increase in prevalence and longevity of patients with T2DM, but also due to improved survival after myocardial infarction and a more systematic screening for the combination.