Features of management of patients with chronic heart failure and diabetes mellitus

SCODIAC was a pilot study that revealed an increase in the use of SGLT2i in 123 outpatient patients with heart failure (HF) and type 2 diabetes mellitus. The SCODIAC-II study, the second phase of the program, was conducted on a larger group of patients in order to identify diagnostic and therapeutic pathways and check whether the use of innovative antidiabetic treatment methods can change echocardiographic parameters and methods of cardiovascular therapy. This retrospective study involved 406 patients with CH-diabetes referred to cardiologists and diabetologists from the relevant medical areas of the campaign, and were divided into group a, consisting of 136 patients with preserved ejection fraction (CH-pEF) (>45%), and group b, consisting of 270 patients with reduced efficiency factor (HFrEF) (POS. 45%). All patients periodically underwent clinical and echocardiographic examinations. Antidiabetic therapy was replaced after 1 year by the wider use of GLP1-AR, gliptins and SGLT2i. Cardiovascular therapy has also been modified due to the increased use of sacubitril/valsartan and a decrease in ACE and ARB levels in patients with HF reflux. During echocardiography, the E, Rate A, and E/e' ratio were significantly reduced in 25 patients with HF-pEF and 60 patients with HF-rEF treated with SGLT2i, both in relation to the entire sample of subjects at the beginning of the study, and in other patients with diabetes mellitus. The LAVi result decreased only in patients with hf-pEF, while EF increased only in patients with hf-rEF. The approach to patients with HF and diabetes mellitus should be carried out in medical institutions, be interdisciplinary and integrated. SGLT2i can improve left ventricular function in patients with refractory to HF and replace cardiovascular therapy in almost this category of patients.The test registration protocol was approved by the Ethics Committee of the Federico II University of Naples and registered ClinicalTrial.gov (CT04375943). The principles set out in the Helsinki Declaration have been observed.