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Problems, Pitfalls and Encouraging Information on Patients with Diabetes and Heart Failure

bleak when compared to those without diabetes, and hence, there is a need for improved treatment strategies in this unfavourable situation [6] . In this context, the report from the Norwegian Heart Failure Registry in this issue of Cardiolog y [7] , indicating that, following adjustment for comorbidities, outpatients with diabetes and heart failure have a similar prognosis to those without diabetes, is encouraging although surprising. In a recent national report from another Scandinavian country, Sweden, diabetes was indeed an independent predictor of mortality with an adjusted odds ratio of 1.60 (95% confidence interval 1.50–1.71) [5] . An important difference between these 2 studies is that the Norwegian report is based on outpatients, while the Swedish study reports on hospitalised patients and outpatients in specialist care. A contributory reason for the divergent findings may therefore be that the Norwegian population consisted of patients with less advanced disease. The age distribution gives support to this assumption, with a mean age of 69 years for patients with diabetes in the Norwegian study and of 74 years in the Swedish study. Moreover, the median survival was 64 months in the Norwegian patients with diabetes and heart failure compared to 42 months in the Swedish population. The very first report on the unfavourable relation between coronary artery disease and diabetes, including the dismal prognosis if combined with heart failure, was probably that by Sievers, Blomquist and Biörck in 1954 [1] . They did not receive the attention they deserved, and it is Kannel and his collaborators [2] who are usually referred to as the pioneers in this field due to their presentation of similar data from the Framingham Study about 20 years later. Sadly, it seems that the scenario has not changed over the years. Despite improved contemporary diabetes management, a recent analysis from the UK reported a 1.6fold risk increase of heart failure development in the presence of type 2 diabetes compared with the general population [3] . Common explanations for this increased risk are comorbidities like hypertension and coronary artery disease, but specific diabetes cardiomyopathy, including deranged myocardial metabolism and fibrosis, has also been suggested [4] . The present trend of improved survival following a myocardial infarction, even in people with diabetes, that leaves them alive but with coronary artery disease and myocardial injuries, may, in the future, increase the prevalence of diabetes in heart failure populations [5] . Unfortunately, the long-term prognosis for diabetes patients hospitalised for heart failure remains Received: February 23, 2016 Accepted: February 24, 2016 Published online: April 28, 2016