Diabetes Mellitus Type 2 and Heart Failure - from Pathophysiology to Treatment

Diabetes mellitus and heart failure form a potentially fatal vicious spiral as both entities occur in combination and aggravate one another. In its early stages, heart failure manifests as an amplifying process that is difficult to diagnose and treat. Asymptomatic patients do not necessarily develop overt symptoms. The myocardial metabolism is essential for organ performance through nutrient supply and the formation of reactive metabolites responsible for glucotoxicity and lipotoxicity. Metabolically active substances such as SGLT-2 inhibitors have shown beneficial effects even in the absence of diabetes, and are gaining relevance alongside traditional heart failure treatment. This review focuses on pathological mechanisms, diagnostic options and opportunities for treating heart failure and diabetes.