Heart Failure, Diabetes Mellitus, and Chronic Kidney Disease: A Clinical Conundrum.

Type 2 diabetes mellitus and heart failure (HF) commonly coexist, with diabetes mellitus occurring in ≈25% of patients with chronic HF and ~40% in those hospitalized with acute HF. Importantly, the presence of diabetes mellitus in HF is associated with reduced survival and increased rates of hospitalization compared with HF patients without diabetes mellitus. Despite the common and dangerous coexistence of diabetes mellitus and HF, the optimal management of diabetes mellitus in patients with established HF is not well defined, and the presence of HF complicates the pharmacological treatment of hyperglycemia. For example, thiazolidinediones are associated with greater rates of HF hospitalization and should be avoided in symptomatic HF patients. Additionally, the risk of hypoglycemia with sulfonylureas and insulin may be particularly relevant.