HbA1c was available in 1072/3023 (35%) of the patients in CHARM-Preserved and 428 patients with a HbA1c measurement in this trial had a history of diabetes (Table 1). Patients with diabetes were older, had a higher BMI, more evidence of coronary heart disease, worse NYHA class, higher heart rate, lower estimated glomerular filtration rate (eGFR) and greater use of loop diuretics compared to those with normoglycemia. Patients with previously undiagnosed diabetes and those with prediabetes had a clinical picture in between individuals with known diabetes and those with normoglycemia (Table 1).
HbA1c was available in 1578/4576 (34%) of individuals in CHARM-Alternative and CHARM-Added, and 558 patients in these trials with a HbA1c measurement had a history of diabetes (Table 2). Similar to what was observed in HFpEF, we found that patients with known or undiagnosed diabetes were older, had a worse NYHA class distribution and kidney function and were more likely to have evidence of coronary heart disease.
Only 18% of patients with HFpEF and 16% of patients with HFrEF were normoglycemic.
Prediabetes was more common than normoglycemia in both types of HF: 20% in patients with HFpEF and 22% in those with HFrEF (p = 0.25).
The prevalence of undiagnosed diabetes was also high, but was less common in patients with HFpEF compared with HFrEF (22 vs. 26%, p = 0.01). Conversely, the prevalence of known diabetes was higher in patients with HFpEF (40 vs 35%, p = 0.02). As a result, the prevalence of any diabetes (diagnosed and previously undiagnosed) was 62% in each study.
HFpEF and HFrEF patients with diagnosed diabetes were at significantly higher risk of both the primary composite outcome, and all-cause mortality, compared with normoglycemic patients (Figs. 1 and 2). The rates of both outcomes of interest were higher in patients with undiagnosed diabetes and prediabetes, compared with normoglycemic patients, p < 0.001 for trend across dysglycemia categories for both HFpEF and HFrEF.