Malene N. Demant, MD, from Copenhagen University in Denmark, and colleagues examined the correlation between heart failure severity, defined by loop-diuretic dosage, and the risk of developing diabetes. All Danish patients discharged from hospitalization for first-time heart failure in 1997–2010 were followed until a claimed prescription for hypoglycemic agents, death, or through Dec. 31, 2010. The authors estimated the correlation of loop-diuretic dosage 90 days after discharge with the risk of diabetes.
The researchers classified the 99,362 patients into five loop-diuretic groups: 31% used no loop diuretics; 25% used >0–40mg/day; 17% used >40–80mg/day; 12% used >80–159mg/day; and 15% used ≥160mg/day. Overall, 8% of patients developed diabetes. There was a dose-dependent correlation for loop-diuretic dosage with elevated risk of developing diabetes. The risk was attenuated with concurrent use of renin-angiotensin system inhibitors (RASis; P value for interaction<0.0001). The adjusted hazard ratios for developing diabetes for groups 2 to 5 vs. group 1 (no loop diuretics) were 1.16, 1.35, 1.48, and 1.76 with RASi treatment; and 2.06, 2.28, 2.88, and 3.02 without RASi treatment.
“Increased awareness of risk of diabetes associated with severe heart failure is warranted,” the authors write.
Several authors disclosed financial ties to Novo Nordisk.