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Diabetes: Difference between revisions
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===Treatments and outcomes=== | ===Treatments and outcomes=== | ||
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!colspan="3"|Heart failure and diabetes<cite>34</cite> | |||
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|bgcolor="#CCCCFF" colspan="3"| | |||
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!Recommendation | |||
!Class<sup>a</sup> | |||
!Level<sup>b</sup> | |||
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|ACE-inhibitors are recommended as first-line therapy in diabetic patients with reduced left ventricular dysfunction with or without symptoms of heart failure | |||
!I | |||
!C | |||
|- | |||
|Angiotensin-II receptor blockers have similar effects in heart failure as ACE-inhibitors and can be used as an alternative or even as added treatment to ACE-inhibitors | |||
!I | |||
!C | |||
|- | |||
|BBs in the form of metoprolol, bisoprolol, and carvedilol are recommended as first-line therapy in diabetic patients with heart failure | |||
!I | |||
!C | |||
|- | |||
|Diuretics, in particular loop diuretics, are important for symptomatic treatment of diabetic patients with fluid overload owing to heart failure | |||
!IIa | |||
!C | |||
|- | |||
|Aldosterone antagonists may be added to ACE-inhibitors, BBs, and diuretics in diabetic patients with severe heart failure | |||
!IIb | |||
!C | |||
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|bgcolor="#CCCCFF" colspan="3"|'''<sup>a</sup>Class of recommendation.''' | |||
'''<sup>b</sup>Level of evidence.''' | |||
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According to the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD) Guidelines,<cite>31</cite> there are very few clinical trials on heart failure treatment specifically for diabetic patients. Information on treatment efficacy of various drugs is therefore based on diabetic subgroups included in various heart failure trials. A disadvantage of this is that the subgroups are not always well defined as regards the diabetic state and treatment. Most data favor a proportionately similar efficacy in patients with and without diabetes. Traditional treatment of heart failure in diabetic patients is based on diuretics, ACE-inhibitors, and Beta-blockades, as outlined in other guidelines.<cite>44</cite> Moreover, it is assumed that meticulous metabolic control should be beneficial in heart failure patients with diabetes. | According to the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD) Guidelines,<cite>31</cite> there are very few clinical trials on heart failure treatment specifically for diabetic patients. Information on treatment efficacy of various drugs is therefore based on diabetic subgroups included in various heart failure trials. A disadvantage of this is that the subgroups are not always well defined as regards the diabetic state and treatment. Most data favor a proportionately similar efficacy in patients with and without diabetes. Traditional treatment of heart failure in diabetic patients is based on diuretics, ACE-inhibitors, and Beta-blockades, as outlined in other guidelines.<cite>44</cite> Moreover, it is assumed that meticulous metabolic control should be beneficial in heart failure patients with diabetes. | ||