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Heart failure in diabetes: effects of anti-hyperglycaemic drug therapy

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1 Heart failure in diabetes: effects of anti-hyperglycaemic drug therapy
Prof Richard E Gilbert, MBBS, Prof Henry Krum, MBBS  The Lancet  Volume 385, Issue 9982, Pages (May 2015) DOI: /S (14) Copyright © 2015 Elsevier Ltd Terms and Conditions

2 Figure 1 Age-associated prevalence of heart failure in diabetic and non-diabetic individuals Reproduced from Nichols and colleagues4 The Lancet  , DOI: ( /S (14) ) Copyright © 2015 Elsevier Ltd Terms and Conditions

3 Figure 2 Hazard ratios (HRs), with 95% CIs as floating absolute risks, as an estimate of association between category of updated mean haemoglobin A1c (HbA1c) concentration and heart failure Reference category (HR 1·0) is HbA1c <6% with log linear scales. p value shows contribution of glycaemia to multivariate model. Data adjusted for age at diagnosis of diabetes, sex, ethnic group, smoking, presence of albuminuria, systolic blood pressure, HDL and LDL cholesterol, and triglyceride. Reproduced with permission from Stratton and colleagues.24 The Lancet  , DOI: ( /S (14) ) Copyright © 2015 Elsevier Ltd Terms and Conditions

4 Figure 3 Effects in trials of more versus less intensive glycaemic control on myocardial infarction (fatal or non-fatal) and heart failure resulting in admission to hospital or death The diamond incorporates the point estimate, represented by the vertical dashed line, and the 95% CI of the overall effect for each outcome. The hazard ratios (HRs) are given for more-intensive compared with less-intensive glucose control. ΔHbA1c=mean haemoglobin A1c (HbA1c) of more-intensive group minus mean HbA1c of less-intensive group. UKPDS follow-up truncated at 5 years from the time of randomisation. Reproduced with permission from Turnbull and colleagues.25 The Lancet  , DOI: ( /S (14) ) Copyright © 2015 Elsevier Ltd Terms and Conditions

5 Figure 4 Forest plot of heart failure in trials of patients receiving a dipeptidylpeptidase-4 (DPP4) inhibitor versus all comparators Reproduced with permission from Wu and colleagues.59 MH=Mantel-Haenszel. The Lancet  , DOI: ( /S (14) ) Copyright © 2015 Elsevier Ltd Terms and Conditions

6 Figure 5 Time course of fall in urinary sodium excretion (UNaV) during insulin administration Bars show mean values of six patients with standard error of the mean (SEM). Plasma insulin concentrations during insulin infusion were constant for each patient (range for the group was 98–193 μU/mL). Steady-state water diuresis was maintained throughout control and insulin administration periods. Reproduced with permission from De Fronzo and colleagues.71 The Lancet  , DOI: ( /S (14) ) Copyright © 2015 Elsevier Ltd Terms and Conditions

7 Figure 6 Component cardiovascular endpoint events for all phase 2b/III studies of dapagliflozin Reproduced from the US Food and Drug Administration.102 The Lancet  , DOI: ( /S (14) ) Copyright © 2015 Elsevier Ltd Terms and Conditions


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