The continuum of abnormal glucose tolerance (AGT) from insulin resistance (IR) and impaired glucose tolerance to diabetes, is found in 40 – 60% of patients with heart failure (HF), and all have a deleterious effect on patient outcomes. Dr. Wolfram Doehner (DE) emphasised the dual causal relationship between AGT and HF, and the complex metabolic pathways that lead to AGT in HF. For the patient who is diabetic, the relationship between hyperglycaemia and heart failure is a continuum stated Dr. A. Avagaro (IT). Dr. Avagaro further noted the challenges in glycaemic control for patients with HF, as some drugs may be contraindicated in ischaemia and as HF progresses. Dr. Clyde Yancey (US) stressed that development of diabetic cardiomyopathy is a risk for the 180 million people with diabetes worldwide, especially if they have retinopathy. High mobility group box-1 protein may be a missing link between diabetes and HF, and a potential novel therapeutic target, said Dr. Yancey. Given the deleterious effect of AGT on patients with HF, should we be routinely screening patients without known diabetes and if so how? Dr. Mamas (UK) advocated the use of the FINDRISK score to identify patients at highest risk of AGR, followed by an oral glucose tolerance test and HbA1c, as fasting glucose alone is likely to miss up to 80% of patients with AGT. All speakers identified the importance of AGT in patients with HF, and the need for better methods to prevent, detect and treat patients. Although new pharmacologic agents are needed, lifestyle changes, especially exercise, are important and effective treatment modalities.
Impaired glucose tolerance in heart failure
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