Association of heart failure severity with risk of diabetes: a Danish nationwide cohort study
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Aims/hypothesis Heart failure has been suggested to increase the risk of developing diabetes. We investigated the relation between heart failure severity, defined by loop-diuretic dosage, and the risk of developing diabetes in a nationwide cohort of patients with heart failure.Methods We followed all Danish patients discharged from hospitalisation for first-time heart failure in 1997-2010, without prior use of hypoglycaemic agents, until a claimed prescription for hypoglycaemic agents, death or 31 December 2010. The association of loop-diuretic dosage (furosemide equivalents) 90 days after discharge (study baseline) with risk of diabetes was estimated by multivariate Cox regression models.Results In total, 99,362 patients were included and divided into five loop-diuretic dose groups: 30,838 (31%) used no loop diuretics; 24,389 (25%) used >0-40 mg/day; 17,355 (17%) used >40-80 mg/day; 11,973 (12%) used >80-159 mg/day; and 14,807 (15%) used ≥160 mg/day. A total of 7,958 patients (8%) developed diabetes. Loop-diuretic dosages were associated with an increased risk of developing diabetes in a dose-dependent manner. Concomitant use of renin-angiotensin system inhibitors (RASis) attenuated the risk (p value for interaction <0.0001). Compared with patients using no loop diuretics (group 1), the adjusted HRs (95% CI) for developing diabetes for groups 2-5 respectively were 1.16 (1.07, 1.26), 1.35 (1.24, 1.46), 1.48 (1.35, 1.62) and 1.76 (1.61, 1.92) with RASi treatment, and 2.06 (1.83, 2.32), 2.28 (2.01, 2.59), 2.88 (2.52, 3.30) and 3.02 (2.66, 3.43) without RASi treatment.Conclusions/interpretation In a nationwide cohort of patients with heart failure, severity of heart failure was associated with a stepwise increased risk of developing diabetes. Increased awareness of risk of diabetes associated with severe heart failure is warranted.
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In a Danish nationwide cohort study, 8% of HF patients developed T2DM over 3 years.
“In a Danish nationwide cohort study, 8% of HF patients developed T2DM over 3 years, and the severity of HF was associated with a stepwise increased risk of developing T2DM.54”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [54]
In patients with HF, data from observational and clinical trials demonstrate an increased risk for new-onset T2DM compared to patients without HF.
“In patients with HF, data from observational and clinical trials demonstrate an increased risk for new-onset T2DM compared to patients without HF.”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [54]
Registry data corroborate that the use of renin-angiotensin system inhibitors is associated with attenuated risk for T2DM in HF patients receiving loop diuretics.
“Registry data corroborate that the use of renin-angiotensin system inhibitors is associated with attenuated risk for T2DM in HF patients receiving loop diuretics.54”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [54]
The severity of HF was associated with a stepwise increased risk of developing T2DM.
“and the severity of HF was associated with a stepwise increased risk of developing T2DM.54”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [54]
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- Authors
- Demant, M. N., Gislason, G. H., Køber, L., Vaag, A., Torp-Pedersen, C., & Andersson, C.
- Affiliations
- Gentofte Hospital (DK)
- University of Copenhagen (DK)
- Aalborg University (DK)
- Corresponding author
- Demant, Malene N.
- ORCID
- Venue
- Diabetologia
- Published
- 2014-05-22
- Volume
- 57
- Issue
- 8
- Pages
- 1595-1600
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2134947215
- Cited by
- 45
- References
- 34
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 7 · 2023: 1 · 2022: 5 · 2021: 4 · 2020: 3 · 2019: 8 · 2018: 4 · 2017: 3 · 2016: 2 · 2015: 2 · 2014: 4
- FWCI
- 2.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- heart failure, diabetes risk, loop diuretics, furosemide, heart failure severity, renin-angiotensin system inhibitors, dose-dependent association, antidiabetic drugs, cardiovascular risk factors
- MeSH terms
- Aged, Aged, 80 and over, Denmark, Diabetes Mellitus, Type 2, Female, Heart Failure, Humans, Male, Middle Aged, Prognosis, Registries, Risk, Severity of Illness Index, Cohort Studies, Incidence
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