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The guidelines reflect the international consensus on the most efficient way to treat a pacient, based on the experts opinions and on the data from clinical trials, which means that the impact on clinical day-today practice should be major!

It was observed that the number of HF patients treated according to the recommendations of the guidelines is much less than expected, far from being optimal. Unfortunately, this is the case not only with HF, but, also, with hypertension or coronary artery disease! It has been, also, noticed that the administered doses are far from those recommended. We must not forget the importance of lifestyle changes, especially when we refer to diabetic, HF patients.

No medical treatment has benefit, if the lifestyle changes are not followed.

Diagnostic Pathology: Cytopathology

What does medical evidence tell us? That, indeed, diabetic HF patients benefit from standard, lifeprolonging HF medical therapy. But, severe hypoglycaemia is extremely rare in type 2 diabetes. Beneficial effects of the vasodilating β-blockers include improved insulin sensitivity, decrease in the level of triglycerides, improved renal blood flow and reduction of albuminuria. Anyway, aldosterone antagonists may be added to ACE inhibitors, β-blockers and diuretics loop diuretics in diabetic patients with severe HF class IIb, level of evidence C.

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Patients between 18 and 39 years old, with type 1 or type 2 DM, should receive statins in the presence of other risk factors nephropathy, poor glycaemic control, metabolic syndrome, atherosclerosis manifestations class IIb, level of evidence C.

Endometrial cancer peritoneal washings the device therapy for Endometrial cancer peritoneal washings implantable cardioverter defibrillators - ICD, cardiac resynchronization therapy - RCTthey both reduce morbidity and mortality in certain subsets of HF patients, but the major device clinical trials did not include analyses for the subgroup of diabetic patients. The medical treatment for DM determines improved glycaemic control, with beneficial effect in HF improvement of myocardial glucose utilization and decrease of free fatty acids.

  • Notiuni de Anatomie Patologica
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ADA and EASD consensus statement recommends using an algorythm that promotes the preferential use of older agents, including metformin, sulfonylureas and insulin. This algorithm takes into account the evidence for HbA1c-lowering for each agent, the synergistic effects of multiple agents and cost-effectiveness report.

The ADA guidelines established that Metformin is contraindicated in patients with HF, due to concerns about lactic acidosis.

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But, in fact, Metformin is used on a large scale in HF and incidence of lactic acidosis is not very high. Lactic acidosis, a potentially fatal adverse effect, is extremely rare and is associated, almost exclusively, with other risk factors renal or hepatic disease. Endometrial cancer peritoneal washings might have beneficial effects on myocardial function, but it could be associated with increased mortality.

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Thiazolidinediones, insulin sensitizers used as glucose-lowering drugs in the treatment of diabetes, represent a controversial treatment in HF patients, due to the risk of fluid retention, with decrease in haemoglobin and haematocrit, with oedema and weight gain about kgwith worsening of HF symptoms. When combined with Insulin, the rate of oedema increases even more.

Notiuni de Anatomie Patologica

All these are just a few reminders of the complex challenging treatment of heart failure associated with diabetes. From case to case, we have to individualize every approach, taking into consideration the particularities of each particular patient hypertension, coronary artery disease, arrhythmias, significant dyslipidemia, comorbidities associated, that, maybe, will restrict our choice of treatment, retinopathy, nephropathy, chronic kidney disease or end-stage renal failure etc.

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And the answer should be, judging from our experience, cardiologists and diabetologists together! They have to cooperate, to offer to heart failure diabetic patients, optimal medical and not only treatment recommended drugs and target-dosesfor heart failure, and also for diabetes, and to plucni paraziti kod pasa their combination regarding the eventual adverse events.

Fonarow GC, Srikanthan P.

Încărcat de

Diabetic cardiomyopathy. Endocrinol Metab Clin N Am ; Diabetic cardiomyopathy: evidence, mechanisms and therapeutic implications. Endocr Rev ; Heart failure prevalence, incidence and mortality in the elderly with diabetes.

Diab Care ; Prevalence of left ventricular systolic dysfunction and heart failure in the echocardiographic Heart of England sreening study: A population based study. Lancet ; The epidemiology of heart failure: the Endometrial cancer peritoneal washings study.