Diabetes and Heart Failure
At the most recent HeartBrothers Patient Support Group meeting, Tufts Medical Center's Dr. Richard Siegel spoke about the links between heart failure and diabetes and emphasized the importance of diet, exercise, and education in staying healthy.
Up to 50% of heart failure patients will develop diabetes, according to Siegel, an endocrinologist who focuses on diabetes, obesity, lipids, and metabolic diseases.
“Diabetes is a risk factor for heart failure,” Siegel said. “There are coexisting factors. High sugars over time are bad for blood vessels. A lot of it may be related to weight. With type 2 diabetes with excess weight, we know that there can be obesity-related cardiomyopathy.”
It’s important for patients to learn what their blood sugar numbers mean and then set goals, Siegel said. While these goals differ from patient to patient, “most of the time we’re aiming for 90-130 mg per deciliter before meals and under 160-180 after meals.”
Once goals are identified, doctors and patients can discuss medication, diet, and exercise.
Monitors & Medication
Siegel recommended the new continuous glucose monitors (CGMs), including Freestyle Libre and Dexcom G6. “They are very, very valuable, giving sugars every few minutes. Used together with a food log, and activity log, they give context to tell us about blood sugars.”
Some newer medications can be especially beneficial for patients with heart failure, including SGL2 inhibitors, which lower blood sugar in adults with type 2 diabetes.
“They’ve also been shown to reduce the risks of hospitalization for heart failure. They’re an essential part of the treatment plan,” Siegel said.
And of course, there’s insulin. “Insulin continues to be the heart and soul and main treatment for many of the patients, especially in the hospital.” There are short and long-acting forms of insulin.
Diet
Some people can manage their blood sugar levels without medicine, with lifestyle changes. Siegel answered several questions about eating habits.
“In a nutshell, you aim for as much of a plant-based and unprocessed diet as you’re able to do. I’m not looking to make people vegetarians or vegans, but even swapping out a few things can help sugars, weight, and other outcomes we’re aiming for. Dietary changes are essential.”
He suggested that people work with dieticians to discuss different types of eating plans.
Getting Active
Siegel also emphasized the importance of exercise, while acknowledging that it can be difficult for heart failure patients.
“We still want to come up with as much of an exercise prescription as possible. I am a big fan of cardiac rehab.”
Keeping a healthy weight is critical, Siegel said. For women, that means a waist circumference of fewer than 35 inches and for men, it’s under 40 inches.
“Belly fat correlates with fat in the liver and risk for high triglycerides,” he explained. “That visceral fat is releasing fatty acids and depositing them in the heart and other organs. We really do want to reduce that belly fat.”
HeartBrothers' Patient Support Group meets virtually the second Thursday each month at 6 pm ET.