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Heart failure - chronic - Management
How should I manage someone with diabetes as a comorbidity in heart failure?
- Diabetes mellitus is a frequent comorbidity in people with heart failure and may increase the progression of heart failure.
- Good glycaemic control should be maintained (not only as standard management of diabetes, but also because it reduces thirst that can lead to excessive fluid intake).
- If using metformin, renal function should be monitored and the use of metformin reviewed if the serum creatinine level is greater than 130 micromol/L or the estimated glomerular filtration rate is less than 45 mL/min/1.73 m2.
- Thiazolidinediones (glitazones) are contraindicated in people with heart failure.
- Non-selective beta-blockers can mask warning signs of hypoglycaemia (for example tremor and tachycardia). A cardioselective beta-blocker (such as bisoprolol or nebivolol) is therefore preferred in people with diabetes.
- See the CKS topic on Diabetes type 2 for details of managing glucose control in people with type 2 diabetes.
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