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Observational Study
. 2021 Apr;8(2):1711-1716.
doi: 10.1002/ehf2.13235. Epub 2021 Feb 11.

Type 2 diabetes and heart failure: insights from the global DISCOVER study

Suzanne V Arnold  1   2 , Kamlesh Khunti  3 , Fabrice Bonnet  4 , Bernard Charbonnel  5 , Hungta Chen  6 , Javier Cid-Ruzafa  7 , Andrew Cooper  8 , Peter Fenici  8 , Marilia B Gomes  9 , Niklas Hammar  10   11 , Linong Ji  12 , Gabriela Luporini-Saraiva  6 , Jesús Medina  13 , Antonio Nicolucci  14 , Larisa Ramirez  15 , Marina V Shestakova  16 , Iichiro Shimomura  17 , Filip Surmont  8 , Fengming Tang  1 , Jiten Vora  18 , Hirotaka Watada  19 , Mikhail Kosiborod  1   2 ; DISCOVER investigators
Affiliations
Observational Study

Type 2 diabetes and heart failure: insights from the global DISCOVER study

Suzanne V Arnold et al. ESC Heart Fail. 2021 Apr.

Abstract

Aims: Heart failure (HF) is increasingly recognized as a major cause of morbidity and mortality in patients with type 2 diabetes (T2D), but the global epidemiology and treatment of HF in T2D are not well defined. This study aimed to examine the global prevalence of HF and the incidence of HF over 3 years of follow-up in patients with T2D [by presence and absence of co-existing coronary artery disease (CAD)].

Methods and results: DISCOVER was a 3 year, prospective, observational study of T2D patients enrolled at initiation of second-line glucose-lowering therapy. Among 14 057 patients with T2D from 36 countries, 289 (2.1%) had a diagnosis of HF at enrolment; median prevalence across countries was 2.0% (inter-quartile range 1.0-3.1%). Patients with HF at baseline were more likely to be older [HF vs. no HF: 67 ± 12 vs. 57 ± 12 years, standardized difference (StDiff) = 84%] and have longer duration of T2D (8.1 ± 7.2 vs. 5.6 ± 5.2 years, StDiff = 40%), CAD (44% vs. 6%, StDiff = 97%), atrial fibrillation (21% vs. 1%, StDiff = 66%), and kidney disease (23% vs. 4%, StDiff = 55%). Patients with HF were less likely to be on metformin (66% vs. 79%, StDiff = 28%) and thiazolidinediones (5.5% vs. 10.6%, StDiff = 19%) but had similar use of other glucose-lowering medications. Among 9313 patients with follow-up data, there were 70 incident cases of HF, which translates to an incidence of 2.6 cases per 1000 person years. Of these incident HF cases, 60% occurred in the absence of pre-existing or concomitant CAD, and 73% were diagnosed in the outpatient setting.

Conclusions: In a large, global cohort of patients with T2D, the majority of incident cases of HF occurred in outpatients and in the absence of known CAD. These findings highlight the need for greater awareness of HF risk in patients with T2D.

Keywords: Diabetes mellitus; Epidemiology; Heart failure.

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Conflict of interest statement

K.K., F.B., B.C., M.B.G., L.J., A.N., M.V.S., I.S., J.V., H.W., and M.K. are members of the DISCOVER Scientific Committee and received financial support from AstraZeneca to attend DISCOVER planning and update meetings. S.V.A., F.T., and M.K. are employees of Saint Luke's Mid America Heart Institute, which has received research funding from AstraZeneca for participation in DISCOVER. H.C., A.C., P.F., G.L.‐S., J.M., L.R., and F.S. are employees of AstraZeneca. N.H. and J.V. are former employees of AstraZeneca. J.C.‐R. is an employee of Evidera. In addition, K.K. has received honoraria from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Novo Nordisk, Sanofi, Takeda, Servier, and Pfizer and research support from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Sanofi, and Pfizer and also acknowledges support from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care—East Midlands (NIHR CLAHRC—EM) and the National Institute of Health Research (NIHR) Leicester Biomedical Research Centre. B.C. has received honoraria from AstraZeneca, Boehringer Ingelheim, Lilly, Merck Sharpe & Dohme, Novartis, Novo Nordisk, Sanofi, and Takeda. M.B.G. has received honoraria from Merck Serono. M.K. has received honoraria from Amgen, Applied Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Eisai, GlaxoSmithKline, Glytec Systems, Intarcia, Janssen, Merck (Diabetes), Novartis, Novo Nordisk, and Sanofi and research support from AstraZeneca and Boehringer Ingelheim. L.J. has received honoraria from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol‐Myers Squibb, Eli Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Takeda, Sanofi, and Roche and research support from AstraZeneca, Bristol‐Myers Squibb, Eli Lilly, Merck Sharp & Dohme, Novartis, Roche, and Sanofi. A.N. has received honoraria from AstraZeneca, Eli Lilly, Medtronic, and Novo Nordisk and research support from Artsana, Dexcom, Novo Nordisk, and Sanofi. M.V.S. has received honoraria from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharpe & Dohme, Novo Nordisk, Sanofi, and Servier and research support from Novo Nordisk and Sanofi. I.S. has received honoraria from Astellas Pharma, AstraZeneca, Boehringer Ingelheim, Kowa, Merck Sharp & Dohme, Mitsubishi Tanabe Pharma, Novo Nordisk, Ono Pharmaceutical, Sanwa Kagaku Kenkyusho, and Takeda Pharmaceutical and research support from Astellas Pharma, AstraZeneca, Daiichi Sankyo, Eli Lilly, Japan Foundation for Applied Enzymology, Japan Science and Technology Agency, Kowa, Kyowa Hakko Kirin, Midori Health Management Center, Mitsubishi Tanabe Pharma, Novo Nordisk, Ono Pharmaceutical, Sanofi, Suzuken Memorial Foundation, and Takeda Pharmaceutical. H.W. has received honoraria from Astellas Pharma, AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo, Dainippon Sumitomo Pharma, Eli Lilly, Kissei Pharma, Kowa, Kyowa Hakko Kirin, Merck Sharp & Dohme, Mitsubishi Tanabe Pharma, Novartis, Novo Nordisk, Ono Pharmaceutical, Sanofi, Sanwa Kagaku Kenkyusho, and Takeda and research support from Abbott, Astellas Pharma, AstraZeneca, Bayer, Benefit One Health Care, Boehringer Ingelheim, Bristol‐Myers Squibb, Daiichi Sankyo, Dainippon Sumitomo Pharma, Eli Lilly, Johnson & Johnson, Kissei Pharma, Kowa, Kyowa Hakko Kirin, Merck Sharp & Dohme, Mitsubishi Tanabe Pharma, Mochida Pharmaceutical, Nitto Boseki, Novartis, Novo Nordisk, Ono Pharmaceutical, Pfizer, Sanofi, Sanwa Kagaku Kenkyusho, Taisho Toyama Pharmaceutical, Takeda, and Terumo Corp. M.K. has received honoraria from Amgen, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Glytec Systems, Intarcia, Janssen, Merck, Novo Nordisk, Novartis, Sanofi, and ZS Pharma and research support from AstraZeneca and Boehringer Ingelheim.

Figures

Figure 1
Figure 1
Cumulative prevalence of heart failure (HF) over time in patients with type 2 diabetes. Patients from Canada, Denmark, Japan, and Norway excluded from these calculations.
See this image and copyright information in PMC

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