Type 2 Diabetes and Heart Failure: Can We Break the Link?

By Ambarish Pandey, M.D.

Assistant Professor of Internal Medicine

Diabetes affects more than 30 million adults in the United States and is linked to heart failure, a clinical syndrome with a poor long-term prognosis. Control of traditional risk factors such as blood pressure, cholesterol, and glucose is important in decreasing the chances of developing heart failure but the risk is still high in patients with Type 2 diabetes. As part of the heart failure prevention program at UT Southwestern, our research team has been focused on understanding why patients with Type 2 diabetes develop heart failure and if there are ways in which it can be prevented. Several studies from our research group were presented at the 2020 American Heart Association Scientific Sessions.

Obesity and diabetes are often seen together in patients. Obesity is defined based on body mass index (BMI), which accounts for height and weight. However, weight accounts for many different parts of the body, including fat and muscle. Prior work by our group has shown that declines in BMI were linked to lower risk of heart failure. In a study presented at the Scientific Sessions, our research team examined specific body composition measures in Type 2 diabetes. We validated estimated measures of fat mass and lean mass and then showed that declines in estimated measures were associated with lower risk of heart failure. This study suggests that fat mass might be an important target for weight-loss strategies in Type 2 diabetes to reduce the risk of heart failure. Our findings were published in Circulation simultaneously with the AHA Scientific Sessions presentation.

In addition to adiposity, adults with Type 2 diabetes also sometimes have injury, stress, and thickening of the heart muscle as well as inflammation in the body. These are all markers of risk that can be measured through simple blood tests or an electrocardiogram. In another study conducted by our group that pooled data from three large cohort studies, we found that several of these biomarkers together can help identify individuals with Type 2 diabetes who are at high risk for developing heart failure. Additionally, adults with Type 2 diabetes and elevated levels of these biomarkers may be more likely to gain additional benefits from SGLT2 inhibitors, a class of drugs that has proven value in reducing the risk of heart failure. Our study helps shed light into how we may be able to identify which patients might benefit most from such therapies for diabetes.

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