Aetiology of type 2 diabetes

PubMed: Szakterületek: In people with type 2 diabetes the frequency of heart failure HF is increased and mortality from HF is higher than with non-diabetic HF. The increased frequency of HF is attributable to the cardiotoxic tetrad of ischaemic heart disease, left ventricular hypertrophy, diabetic cardiomyopathy and an extracellular volume expansion resistant to atrial natriuretic peptides.

Activation of the renin-angiotensin-aldosterone system and sympathetic nervous systems results in cardiac remodelling, which worsens cardiac function. Reversal of remodelling can be achieved, and cardiac function improved in people with HF with reduced ejection fraction HFrEF by treatment with angiotensin-converting enzyme inhibitors and beta-blockers.

Glucose-lowering drugs can have a negative effect insulin, sulphonylureas, dipeptidyl peptidase-4 inhibitors and thiazolidinedionesa neutral effect alpha-glucosidase inhibitors and glucagon-like peptide-1 receptor agonists or a positive effect sodium-glucose co-transporter-2 inhibitors and metformin.