Modern Approaches to Treatment of Chronic Heart Failure in Patients with Type 2 Diabetes Mellitus

Abstract

The issues of epidemiology, pathophysiology and basic principles of treatment of chronic heart failure in patients with type 2 diabetes mellitus are considered. Attention is paid to both means of glycemic correction and treatment of chronic heart failure directly, taking into account the effectiveness, cardiovascular safety of drugs, as well as their impact on the course and prognosis of chronic heart failure. The results of randomized clinical trials to study the effectiveness of various groups of drugs for the treatment of chronic heart failure in patients with type 2 diabetes mellitus are presented. It is indicated that the overall goal of the treatment of type 2 diabetes mellitus is to achieve and maintain glycemic control, as well as to reduce the risk of long-term complications, in particular chronic heart failure. The goal of chronic heart failure treatment is to improve the clinical condition and quality of life of patients, to reduce the frequency of hospitalizations and mortality. The appointment of some groups of hypoglycemic drugs has a neutral or negative effect on the course and prognosis of chronic heart failure, so their use is limited or not recommended in the treatment of patients with type 2 diabetes mellitus and chronic heart failure. The emphasis is on those classes of drugs that have demonstrated significant advantages in influencing the morbidity and mortality associated with chronic heart failure and type 2 diabetes mellitus in comparison with other drugs, namely, inhibitors of the sodium-dependent glucose cotransporter type 2 and angiotensin receptor inhibitors II and neprilisin (sacubitril / valsartan). Experts call such classes of drugs as sodium-dependent glucose cotransporter type 2, angiotensin receptor inhibitors II and neprilisin, mineralocorticoid receptor antagonists and beta-blockers as the "Fantastic Four", given the significant positive effect of their combined use on the course and prognosis of chronic heart failure. Modern approaches to the treatment of chronic heart failure in patients with type 2 diabetes mellitus are based on the updated guidelines of the European Society of Cardiology for the diagnosis and treatment of acute and chronic heart failure, as well as on the recommendations of the American Diabetes Association for the classification, prevention and treatment of heart failure in patients with diabetes. Conclusion. The most important achievements in recent years, which have significantly improved the treatment outcomes of patients with chronic heart failure and type 2 diabetes mellitus, include: the development of new classes of drugs; conducting large-scale randomized clinical trials that demonstrated the benefits of certain groups of drugs in terms of their impact on the development, course and prognosis of chronic heart failure in type 2 diabetes mellitus, and updated comprehensive and balanced therapy for these patients