Are you seeing people with
type 2 diabetes (T2D) exhibiting:
T2D increases the risk of developing heart failure (HF) both directly, by impairing cardiac function, and indirectly, through associated diseases.1
Early diagnosis of HF and initiation of evidence-based treatments in people with T2D can reduce cardiac damage, improve quality of life and improve patient outcomes.2
4.4 million people in the UK are diagnosed with T2D.4
14% of people with T2D have been diagnosed with HF.5
Every week, T2D leads to 2300 new cases of HF.6
T2D and HF are increasingly common burdens. Observational studies have shown that people with T2D have a two- to threefold increased risk of developing HF compared with individuals without T2D independent of other risk factors such as:1,7
• hypertension
• obesity
• coronary disease
• other metabolic factors
• renal dysfunction
The recent Universal Definition and Classification of HF recognised T2D as a prime risk factor for incident HF, classifying individuals with T2D as being in Stage A.8
Despite this, an independent survey conducted on behalf of Roche Diagnostics showed that only 28% of healthcare professionals consider HF amongst their T2D patients.9
The Universal Definition and Classification of HF is as follows:8
Stages of heart failure
At risk of HF
People who are at risk for heart failure but do not yet have symptoms or structural or functional heart disease
Risk factors for people in this stage include hypertension, coronary vascular disease, diabetes, obesity, exposure to cardiotoxic agents, genetic variants for cardiomyopathy and family history of cardiomyopathy
Pre-HF
People without current or previous symptoms of heart failure but with either structural heart disease, increased filling pressures in the heart or other risk factors
Symptomatic HF
People with current or previous symptoms of heart failure
Advanced HF
People with heart failure symptoms that interfere with daily life functions or lead to repeated hospitalisations
Co-existence of T2D and HF is associated with worse symptoms and quality of life, a greater burden of HF hospitalisation, and higher mortality rates compared to people without T2D.10
T2D and cardiac damage
Several pathophysiological mechanisms underlie the development of HF in T2D, as detailed in the figure below. These contribute to adverse cardiac remodelling and the development of clinical HF in T2D. Each of these mechanisms is a potential therapeutic target for prevention that can delay the development and progression of HF.13
Myocardial ischaemia
Inflammation
Endothelial dysfunction
Extracellular matrix remodelling
Adverse cardiac remodelling
Myocardial substrate switch
FA - fatty acids
Glu - glucose
Autonomic dysfunction
Neurohormonal and RAAS activation
Impaired Ca2+ handling
Diagnosing HF in people with T2D
What is NT-proBNP?
NT-proBNP is a form of natriuretic peptide (NP) released by cardiac tissue in response to volume and/or pressure overload that causes the walls of the heart to stretch. NPs promote natriuresis and diuresis and act as vasodilators, to help regulate this pressure.14
Why test for NT-proBNP?
NP levels can be assessed by measuring either B-type NP (BNP) or N-terminal pro-B-type NP (NT-proBNP). NT-proBNP is the NP test recommended by NICE for suspicion of chronic HF as it as a very high diagnostic sensitivity for HF, is more stable over time and testing in patients with symptoms delivers a fast route to ruling out HF as a diagnosis.15,16
High levels of NT-proBNP are associated with a poor prognosis. Patients with values >2,000 ng/l are at greater risk of death. High levels therefore indicate the need for urgent referral.15,16
Risk assessment in your patients with T2D
In recent years, the circulating NP biomarkers have become increasingly important in relation to HF and, when elevated in the absence of prevalent HF, identify individuals with “pre-HF” at risk for progression to symptomatic disease.8
NT-proBNP may be the earliest sign to detect HF in people with T2D before structural and functional changes become apparent on imaging.17,18
If you have had trouble accessing NT-proBNP or would like to speak to a local representative about using NT-proBNP in patients with T2D, please contact us and we’ll be happy to help.
Triage patients at need of urgent specialist assessment.16
Rule out heart failure and reduce pressure on echocardiography services.19
Support an earlier diagnosis that could reduce hospitalisations and improve quality and length of life.20
Early and accurate diagnosis of heart failure has the potential to reduce rates of misdiagnosis and GP appointments.21
The Pumping Marvellous Foundation (PMF) is the UK’s patient-led heart failure charity. Founder & CEO Nick Hartshorne-Evans, a heart failure patient whose experiences whilst rehabilitating, shaped the Foundation’s goals and principles to improve patient outcomes.
With patient resources available for download by healthcare professionals, Pumping Marvellous takes a patient-centric approach to heart failure diagnosis, ongoing management and care.
References
