American Diabetes Association updates guidelines concerning heart failure


This marks the first time use of cardiac biomarkers for heart failure risk prediction have been included.

December 15, 2023


The American Diabetes Association (ADA) released its “Standards of Care in Diabetes–2024,"1 an annual opportunity for the organization to make new clinical practice recommendations and provide guidance on the components of diabetes care.

For the first time ever, heart-failure testing recommendations have been included in the official guidelines, putting additional focus on this particular complication of diabetes.

In its chapter focusing on Cardiovascular Disease and Risk Management,2 the recommendations for monitoring heart failure in people with diabetes state:


  • 10.39a: Adults with diabetes are at increased risk for the development of asymptomatic cardiac structural or functional abnormalities (stage B heart failure) or symptomatic (stage C) heart failure. Consider screening adults with diabetes by measuring a natriuretic peptide (B-type natriuretic peptide [BNP] or N-terminal pro-BNP [NTproBNP]) to facilitate prevention of stage C heart failure.
  • 10.39b: In asymptomatic individuals with diabetes and abnormal natriuretic peptide levels, echocardiography is recommended to identify stage B heart failure.


"Individuals with both Type 1 and Type 2 Diabetes are recognized as being at increased risk for heart failure, and the number of people diagnosed with diabetes or prediabetes in the U.S. is increasing,” says Dagmar Schumacher, Ph.D., scientific partner, cardiometabolism, Roche Diagnostics. “By recognizing natriuretic peptide measurement as a way to monitor for risk of heart failure in people with diabetes, the ADA is helping to combat incidence rates and improving patient outcomes because preventive measures can be taken before heart failure is even symptomatic."

The guidelines highlight the collaborative efforts of several prominent cardiovascular and diabetes clinical societies including American College of Cardiology (ACC),3,4 American Heart Association (AHA),4,5 Heart Failure Society of America (HFSA)4,5 and ADA2,3 to raise awareness of this particular complication of diabetes. For additional details on the diagnosis, treatment and testing of heart failure in patients with diabetes, the new ADA guidelines report refers readers to its consensus statement, published in Diabetes Care in 2022.3

“According to the 2022 consensus statement, among individuals with diabetes, measurement of a natriuretic peptide or high-sensitivity cardiac troponin is recommended on at least a yearly basis to identify the earliest heart failure stages and implement strategies to prevent transition to symptomatic heart failure,” says Schumacher. “I strongly encourage clinicians who treat people with diabetes to add testing for heart failure risk to the routine blood work for these patients. A relatively inexpensive cardiac biomarker test, such as NT-proBNP, has the potential to identify heart failure earlier in the disease course and enable improved quality of life by starting medications or lifestyle interventions for these patients, sooner.”

Learn more about how annual cardiac biomarker monitoring can improve patient outcomes. 


  1. American Diabetes Association Professional Practice Committee; Standards of Care in Diabetes—2024. Diabetes Care 1 January 2024; 47 47 (Supplement_1).
  2. American Diabetes Association Professional Practice Committee; 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S179–S218.
  3. Pop-Busui R, et al. Diabetes Care. 2022;45(7):1670-1690
  4. Heidenreich, PA et al, 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Card Fail. 2022 May;28(5):e1-e167.
  5. Dunlay SM, et al. Circulation. 2019 Aug 13;140(7):e294-e324.


Dagmar Schumacher, Ph.D., spent 12 years of her career in basic pharmacological research in the cardiovascular, diabetes and cancer disease areas at the Max Planck Institute for Heart and Lung Research and as an assistant professor at the University of Heidelberg, Germany. She joined Roche Diagnostics in 2019 to support point-of-care projects around coagulation and SARS-CoV-2 before moving into her current position as a scientific partner for cardiometabolism.