New-Onset Diabetes in Heart Failure Patients: A Complex Relationship with Clinical Implications

Abstract

The relationship between heart failure and diabetes mellitus (DM) is bidirectional. DM is a known risk factor for the development of heart failure and is related to a worse outcome. On the other hand, some studies have found that heart failure is also associated with a greater incidence of new-onset diabetes. This relationship has been less evaluated and the underlying mechanisms are not fully understood. We present the evidence linking heart failure with insulin resistance and the development of DM, as well as the possible mechanisms. Furthermore, medications that have been shown to improve clinical outcomes in patients with chronic heart failure may be associated with the development of incident diabetes whereas some hypoglycemic agents raise safety concerns in these patients. Therefore, we will consider pharmacologic interventions that can reverse insulin resistance in this specific population.