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Interdisciplinary approach to compensation of hypoglycemia in diabetic patients with chronic heart failure

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Abstract

Diabetes mellitus is a chronic disease requiring lifelong control with hypoglycemic agents that must demonstrate excellent efficacy and safety profiles. In patients taking glucose-lowering drugs, hypoglycemia is a common cause of death associated with arrhythmias, increased thrombus formation, and specific effects of catecholamines due to sympathoadrenal activation. Focus is now shifting from merely glycemic control to multifactorial approach. In the context of individual drugs and classes, this article reviews interdisciplinary strategies evaluating metabolic effects of drugs for treatment of chronic heart failure (CHF) which can mask characteristic hypoglycemia symptoms. Hypoglycemia unawareness and cardiac autonomic neuropathy are discussed. Data suggesting that hypoglycemia modulates immune response are reviewed. The potential role of gut microbiota in improving health of patients with diabetes and CHF is emphasized. Reports stating that nondiabetic CHF patients can have life-threatening hypoglycemia associated with imbalance of thyroid hormones are discussed. Regular glycemic control based on HbA1c measurements and adequate pharmacotherapy remain the priorities in diabetes management. New antihyperglycemic drugs with safer profiles should be preferred in vulnerable CHF patients. Multidrug interactions must be considered. Emerging therapies with reduced hypoglycemia risk, telemedicine, sensor technologies, and genetic testing predicting hypoglycemia risk may help solving the challenges of hypoglycemia in CHF patients with diabetes. Interdisciplinary work may involve cardiologists, diabetologists/endocrinologists, immunologists, gastroenterologists, microbiologists, nutritionists, imaging specialists, geneticists, telemedicine experts, and other relevant specialists. This review emphasizes that systematic knowledge on pathophysiology of hypoglycemia in diabetic patients with CHF is largely lacking and the gaps in our understanding require further discoveries.

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Acknowledgements

This review article was written in a framework of projects supported, in part, by the Russian Science Foundation (#17-15-01111) and by the Ministry of Education and Science of the Russian Federation (#4.8192.2017) (to MS and YA).

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  1. Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111-a Kievskaya Street, Tomsk, Russia, 634012

    Yana Anfinogenova, Elena V. Grakova, Kristina V. Kopieva, Alexander T. Teplyakov & Sergey V. Popov

  2. National Research Tomsk Polytechnic University, 30 Lenin Avenue, Tomsk, Russia, 634050

    Yana Anfinogenova

  3. Cardiovascular Research Center (CVRC), Massachusetts General Hospital, 149 13th Street, Charlestown, MA, 02129, USA

    Maria Shvedova

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  1. Yana Anfinogenova
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  2. Elena V. Grakova
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Correspondence to Yana Anfinogenova.

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Anfinogenova, Y., Grakova, E.V., Shvedova, M. et al. Interdisciplinary approach to compensation of hypoglycemia in diabetic patients with chronic heart failure. Heart Fail Rev 23, 481–497 (2018). https://doi.org/10.1007/s10741-017-9647-y

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