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Exp Clin Endocrinol Diabetes 2024; 132(02): 64-67
DOI: 10.1055/a-2166-6885
German Diabetes Association: Clinical Practice Guidelines

Diabetes Mellitus and the Heart

Katharina Schütt
1   Department of Internal Medicine I – Cardiology, Angiology and Internal Intensive Care Medicine, RWTH Aachen University Hospital, Aachen, Germany
,
Thomas Forst
2   CRS Clinical Research Services Mannheim GmbH, Mannheim, Germany
,
Andreas L. Birkenfeld
3   Department of Internal Medicine IV, University Hospital Tübingen, Germany
4   Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, German Center for Diabetes Research (DZD e. V.) Germany
,
Andreas Zirlik
5   Department of Internal Medicine – Division of Cardiology, LKH University Hospital Graz, Medical University Graz, Austria
,
Dirk Müller-Wieland
1   Department of Internal Medicine I – Cardiology, Angiology and Internal Intensive Care Medicine, RWTH Aachen University Hospital, Aachen, Germany
,
Nikolaus Marx
1   Department of Internal Medicine I – Cardiology, Angiology and Internal Intensive Care Medicine, RWTH Aachen University Hospital, Aachen, Germany
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Notice of update

The DDG clinical practice guidelines are updated regularly during the second half of the calendar year. Please ensure that you read and cite the respective current version.

UPDATES TO CONTENT COMPARED TO THE PREVIOUS YEAR’S VERSION

Change 1: Recently, another large cardiovascular outcome study, DELIVER, with the SGLT2 inhibitor dapagliflozin, showed that treatment with dapagliflozin significantly reduced the combined endpoint of hospitalization due to heart failure or CV death compared to placebo in patients with an ejection fraction greater than 40%. Predetermined subgroup analyses showed no significant difference between patients with and without DM.

Reason: Relevant new marketing authorisation for the treatment of heart failure with an ejection fraction>40%

Supporting reference: [20]

Change 2: Two studies (FIGARO-DKD and FIDELIO-DKD) investigated the effect of the new non-steroidal mineralocorticoid receptor antagonist finerenone in patients with diabetes, CKD and albuminuria. In both studies, finerenone reduced the risk of kidney failure and cardiovascular events compared to placebo. A prespecified analysis of both studies together (FIDELITY) showed in 13171 patients that finerenone, in combination with optimized RAS blockade, reduced the risk of the composite cardiovascular endpoint consisting of time to cardiovascular death, non-fatal myocardial infarction, non-fatal stroke or hospitalization due to heart failure by 14%. This effect was mainly due to a reduction in hospitalization due to heart failure, although patients with symptomatic heart failure with reduced pumping function were excluded from these studies. Whether finerenone can reduce heart failure outcomes in patients with HFpEF is currently being investigated in a large cardiovascular endpoint study (FINARTS-HF; NCT04435626).

Reason: New treatment options for patients with diabetes and CKD with a positive effect on hospitalization due to heart failure

Supporting reference: [21] [23]



Publication History

Article published online:
23 January 2024

© 2024. Thieme. All rights reserved.

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