Diabetes and Acute Coronary Syndrome

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Questions and Answers

What is the recommended blood glucose level for frequent monitoring in patients with known diabetes or hyperglycaemia?

Glucose levels ≥11.1 mmol/L or ≥200 mg/dL (correct)

Glucose levels ≥8.0 mmol/L or ≥140 mg/dL

Glucose levels ≥22.2 mmol/L or ≥400 mg/dL

Glucose levels ≥16.7 mmol/L or ≥300 mg/dL

What is the recommended initial evaluation for patients with ACS?

Perform 12-lead ECG only

Assess glycaemic status and measure BNP/NT-proBNP

Assess glycaemic status only (correct)

Measure BNP/NT-proBNP only

What is the recommended diagnostic test for patients with suspected heart failure?

Transthoracic echocardiography only

12-lead ECG and chest radiography

Routine blood tests for comorbidities

All of the above (correct)

Which medication is recommended in patients with HFrEF and T2DM to reduce the risk of HF hospitalization and death?

All of the above Signup and view all the answers

What is the recommendation for heart failure screening in patients with diabetes?

Systematic survey for HF symptoms and/or signs of HF at each clinical encounter Signup and view all the answers

What is the recommended test for evaluating heart failure in patients with diabetes?

Measure BNP/NT-proBNP Signup and view all the answers

What is the recommended treatment for patients with HFrEF and diabetes to reduce the risk of HF hospitalization and death?

A combination of SGLT2 inhibitors, sacubitril/valsartan or an ACE-I, beta-blockers, and MRAs Signup and view all the answers

What is the recommended routine blood test for comorbidities in patients with heart failure?

Full blood count, urea, creatinine, electrolytes, lipids, and iron status Signup and view all the answers

Which of the following medications is NOT recommended in patients with diabetes at risk of heart failure or with previous heart failure?

Pioglitazone Signup and view all the answers

What is the recommended treatment strategy for heart failure patients discharged from the hospital?

Early initiation of evidence-based treatment with rapid up-titration to target doses Signup and view all the answers

Which of the following devices is recommended in patients with diabetes and heart failure?

All of the above Signup and view all the answers

What is the recommended action for glucose-lowering treatment in patients with heart failure and diabetes?

Switch to agents with proven CV benefit Signup and view all the answers

Who should be screened for atrial fibrillation?

Patients with diabetes ≥65 years of age Signup and view all the answers

What is the recommended treatment for patients with heart failure and diabetes with signs and/or symptoms of fluid congestion?

Diuretics Signup and view all the answers

Which of the following medications is recommended in patients with HFrEF and diabetes who do not tolerate sacubitril/valsartan or ACE-Is?

ARBs Signup and view all the answers

What is the benefit of using SGLT2 inhibitors in patients with type 2 diabetes and heart failure?

Reducing the risk of heart failure hospitalization or cardiovascular death Signup and view all the answers

Which of the following is NOT a recommendation for the treatment of heart failure patients with left ventricular ejection fraction >40% and diabetes?

Pioglitazone Signup and view all the answers

What is the recommended strategy for reducing heart failure hospitalization or cardiovascular death in patients with type 2 diabetes with or without existing heart failure?

Using SGLT2 inhibitors Signup and view all the answers

Study Notes

Glycaemic Control in Patients with Diabetes and Acute Coronary Syndrome

Assess glycaemic status at initial evaluation in all patients with ACS.
Frequently monitor blood glucose levels in patients with known diabetes or hyperglycaemia (glucose levels ≥11.1 mmol/L or ≥200 mg/dL).

Heart Failure Screening and Diagnosis in Patients with Diabetes

Evaluate for heart failure by measuring BNP/NT-proBNP if suspected.
Conduct a systematic survey for HF symptoms and/or signs of HF at each clinical encounter in all patients with diabetes.
Perform diagnostic tests, including:
- 12-lead ECG.
- Transthoracic echocardiography.
- Chest radiography (X-ray).
- Routine blood tests for comorbidities, including full blood count, urea, creatinine and electrolytes, thyroid function, lipids, and iron status (ferritin and TSAT).

Heart Failure Treatments in Patients with Heart Failure with Reduced Ejection Fraction and Diabetes

Recommend pharmacological treatment in patients with HFrEF (NYHA class II–IV) and diabetes, including:
- SGLT2 inhibitors (dapagliflozin, empagliflozin, or sotagliflozin) to reduce the risk of HF hospitalization and death.
- Sacubitril/valsartan or an ACE-I to reduce the risk of HF hospitalization and death.
- Beta-blockers to reduce the risk of HF hospitalization and death.
- MRAs to reduce the risk of HF hospitalization and death.
Recommend device therapy with an ICD, CRT-P, or CRT-D in patients with diabetes, as in the general population with HFrEF.
Recommend ARBs in symptomatic patients with HFrEF and diabetes who do not tolerate sacubitril/valsartan or ACE-Is, to reduce the risk of HF hospitalization and death.
Recommend diuretics in patients with HFrEF and diabetes with signs and/or symptoms of fluid congestion to improve symptoms, exercise capacity, and HF hospitalization.

Treatment of Heart Failure Patients with Left Ventricular Ejection Fraction >40% and Diabetes

Recommend empagliflozin or dapagliflozin in patients with T2DM and LVEF >40% (HFmrEF and HFpEF) to reduce the risk of HF hospitalization or CV death.
Recommend diuretics in patients with HFpEF or HFmrEF and diabetes with signs and/or symptoms of fluid congestion to improve symptoms, exercise capacity, and HF hospitalization.

Glucose-Lowering Medications in Patients with Type 2 Diabetes with and without Heart Failure

Recommend SGLT2 inhibitors (empagliflozin, canagliflozin, dapagliflozin, ertugliflozin, or sotagliflozin) in patients with T2DM with multiple ASCVD risk factors or established ASCVD to reduce the risk of HF hospitalization.
Recommend SGLT2 inhibitors (dapagliflozin, empagliflozin, or sotagliflozin) in patients with T2DM and HFrEF to reduce the risk of HF hospitalization and death.
Recommend empagliflozin or dapagliflozin in patients with T2DM and LVEF >40% (HFmrEF and HFpEF) to reduce the risk of HF hospitalization or CV death.

Glucose-Lowering Medications with Increased Risk of Heart Failure Hospitalization

Pioglitazone is associated with an increased risk of incident HF in patients with diabetes and is not recommended for glucose-lowering treatment in patients at risk of HF (or with previous HF).
The DPP-4 inhibitor saxagliptin is associated with an increased risk of HF hospitalization in patients with diabetes and is not recommended for glucose-lowering treatment in patients at risk of HF (or with previous HF).

Special Considerations in Patients with Heart Failure and Diabetes

Recommend switching glucose-lowering treatment from agents without proven CV benefit or proven safety to agents with proven CV benefit.

Atrial Fibrillation in Patients with Diabetes

Recommend opportunistic screening for AF by pulse taking or ECG in patients ≥65 years of age and in patients with diabetes.

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Description

This quiz covers recommendations for glycaemic control and heart failure screening in patients with diabetes and acute coronary syndrome.