Scots scientists find ‘sweet spot’ for diabetes treatment

Warning over treatment of diabetics with heart failure. Picture by Peter Byrne/PA Wire

The team from Dundee University argued that patients with heart failure should be treated less aggressively as some anti-diabetic medications have been shown to worsen heart conditions.

Researchers led by Professor Chim Lang found there are harmful effects of under or over-treating diabetes among those patients with heart failure, a condition where the heart muscles become too weak to effectively pump blood around the body.

Diabetes and heart failure are often seen together, as diabetes can cause high levels of glucose in the blood which can affect the artery walls.

“Clinicians have always struggled with how aggressively to treat diabetes in patients with heart failure,” said Professor Lang.

“Our team has now shown the dangers of not getting the balance right as well as which drugs are safer than others. This work will undoubtedly help guide the treatment of diabetes in patients with heart disease.”

The study, published in the European Journal of Heart Failure, considered the records of nearly 1,500 patients between 1993 and 2010 and found increasing risk of premature death in patients whose blood sugar levels were outside of the ideal range.

This included patients whose blood sugar levels were below the ‘sweet-spot’ as a result of intensive treatment, as well as those with levels beyond the higher limit.

Dr Lang said: “We have already seen recent recommendations by the American Diabetes Association to treat elderly diabetic patients less aggressively. Our research suggests this advice should be extended to those patients who suffer with heart failure.”

The study also found that insulin sensitizer drugs, such as metformin, were among the most effective treatment.

This discovery has led to a landmark research study with Professor Lang and his team to explore the potential beneficial cardiac effects of diabetic therapies.

The team were awarded a £203,000 research grant by the European Foundation for the Study of Diabetes to set up the REFORM Trial that will study the cardiovascular effects of SGLT2 inhibitors on patients with diabetes and heart failure.

The medicines are mainly used to treat patients with type 2 diabetes.

“We are the first in the world to pioneer this research which could potentially see this drug treating both diabetes and heart failure simultaneously,” said Professor Lang.

Dr Jagdeep Singh, a clinical research fellow and principal investigator of the REFORM Trial, added: “Using state-of-the-art MRI technology and detailed cardio-pulmonary exercise testing, we are confident that we can determine the exact effect of SGLT2 inhibitor therapy on the cardiovascular system.”

Patients with a history of diabetes and heart failure who would like to participate in the trial can contact the team at 01382 383221 or 0747 607 4105.