Journal of Echocardiography

, Volume 17, Issue 4, pp 177–186 | Cite as

Heart failure in patients with type 2 diabetes mellitus: assessment with echocardiography and effects of antihyperglycemic treatments

  • Katsuomi IwakuraEmail author
Review Article


Heart failure is one of the major cardiovascular complications in patients with type 2 diabetes mellitus (T2DM) and increases the risk of morbidity and mortality. Although active management for heart failure is needed in patients with T2DM, traditional treatment and some new class of antihyperglycemic drugs, such as glucagon-like peptide-1 receptor agonists or dipeptidyl peptidase-4 inhibitors, could not reduce the risk of heart failure. Recent major trials demonstrated sodium–glucose co-transporter-2 (SGLT2) inhibitors improve prognosis of T2DM patients through prevention of heart failure. Both heart failure with reduced ejection fraction and that with preserved ejection fraction (HFpEF) is observed in T2DM patients, and HFpEF is often overlooked and misdiagnosed in these population. Left ventricular hypertrophy, left atrial dilatation, diastolic dysfunction, and subclinical systolic dysfunction indicated as reduced global longitudinal strain are major abnormalities on echocardiography in patients with diabetic cardiomyopathy. These structural and functional changes are also prevalent in the general patients with T2DM, and those with these abnormalities have higher incidence of heart failure than those without them. Glycemic control might improve some of these abnormalities on echocardiography, but it is still unclear whether their improvement could be associated with risk reduction for heart failure. At now, there are only limited data on the effects of DPP-4 inhibitors or SGLT2 inhibitors on echocardiography in T2DM patients. Large-scale trials are needed to clarify how antihyperglycemic drugs affect echocardiographic parameters.


Diabetes mellitus Heart failure Hypertrophy Diastolic function Global longitudinal strain 


Compliance with ethical standards

Conflict of interest

The author received honoraria from AstraZeneca, Ono pharmaceutical, Boehringer-Ingelheim, Eli Lilly and Company, Astellas Pharma, Mitsubishi Tanabe Pharma and Daiichi-Sankyo.

Supplementary material

12574_2019_446_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 12 kb)


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Copyright information

© Japanese Society of Echocardiography 2019

Authors and Affiliations

  1. 1.Division of CardiologySakurabashi Watanabe HospitalOsakaJapan

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