The impact of diabetes on heart failure: opportunities for intervention.

The pathophysiologic processes of diabetes mellitus and heart failure are likely interrelated. In particular, hyperglycemia and insulin resistance can induce myocardial contractile systolic and diastolic abnormalities at the cellular level. Furthermore, patients with heart failure and concomitant diabetes mellitus are more likely to have underlying comorbid conditions resulting in greater vulnerability to adverse consequences. It is reassuring that the majority of patients with diabetes mellitus and heart failure respond to standard heart failure medical regimens comparable to their nondiabetes counterparts. However, the safety profiles of current antidiabetic medications are far from ideal when used in patients with heart failure. Emerging novel therapies that reverse the metabolic and structural changes induced by the diabetic milieu are currently under clinical development, and their potential benefits may even extend beyond the diabetic population.