International Journal of Diabetes in Developing Countries

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International Journal of Diabetes in Developing Countries
Incorporating Diabetes Bulletin

Founder Editors
Late M. M. S. Ahuja Hemraj B. Chandalia, Department of Endocrinology, Diabetes, Metabolism, Jaslok Hospital and Research Center, Mumbai

S.V. Madhu, Department of Endocrinology, University College of Medical Sciences-GTB Hospital, Delhi

Rajeev Chawla, North Delhi Diabetes Centre, Delhi

Executive Editor

Associate Editors
Amitesh Aggarwal, Department of Medicine, University College of Medical Sciences & GTB Hospital, Delhi, India Sudhir Bhandari, Department of Medicine, SMS Medical College and Hospital, Jaipur, India Simmi Dube, Department of Medicine, Gandhi Medical College & Hamidia Hospital Bhopal, MP, India Sujoy Ghosh, Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, India Arvind Gupta, Department of Internal Medicine and Diabetes, Jaipur Diabetes Research Centre, Jaipur, India Sunil Gupta, Sunil’s Diabetes Care n' Research Centre Pvt. Ltd., Nagpur, India Viswanathan Mohan, Madras Diabetes Research Foundation, Chennai, India Krishna G. Seshadri, Sri Balaji Vidyapeeth, Chennai, India Saurabh Srivastava, Department of Medicine, Government Institute of Medical Sciences, Greater Noida, India Vijay Viswanathan, MV Hospital for Diabetes and Prof M Viswanthan Diabetes Research Centre Chennai, India

Statistical Editors
Amir Maroof Khan, Community Medicine, University College of Medical Sciences and GTB Hospital, Delhi Dhananjay Raje,CSTAT Royal Statistical Society, London, Head Data Analysis Group, mds Data Analytics, Nagpur

Rashi Kushwaha

Editorial Assistant

Immediate Past Editor in Chief
GR Sridhar, Endocrine and Diabetes Center, Visakhapatnam

Sanjay Agarwal, Aegle Clinic-Diabetes Care, Pune Jamal Ahmad, Diabetes and Endocrinology Super Speciality Centre, Aligarh S.R. Aravind, Diacon Hospital, Bangalore Sarita Bajaj, Department of Medicine, MLN Medical College, Allahabad Samar Banerjee, Department of Medicine, Vivekananda institute of Medical Sciences, Kolkata Anil Bhansali, Department of Endocrinology, PGIMER, Chandigarh Subhankar Chowdhury, Department of Endocrinology, IPGME&R and SSKM Hospital, Kolkata A.K. Das, Department of Endocrinology, Pondicherry Institute of Medical Sciences, Pondicherry Sidhartha Das, Dean, SCB Medical College and Hospital, Cuttack O.P. Gupta, Emeritus Professor, BJ Medical College, Ahmedabad Jayaprakashsai Jana, Apollo Hospitals, Hyderabad RV Jayakumar, Indian Institute of Diabetes, Trivandrum Shashank R Joshi, Joshi Hospital, Mumbai Ch. Vasanth Kumar, Apollo Hospitals, Hyderabad Vinod Kumar, Department of Medicine, St. Stephens’ Hospital, Delhi Anuj Maheshwari, Department of Internal Medicine, BBD University, Lucknow B.M. Makkar, Dr. Makkar’s Diabetes & Obesity Centre, Delhi C.R. Anand Moses, The Tamil Nadu Dr. MGR Medical University, Chennai C. Munichoodappa, The Bangalore Diabetes Hospital, Bengaluru Jayant Panda, Department of Medicine, SCB Medical College, Cuttack Vijay Panikar, Department of Endocrinology and Diabetes, Lilavati Hospital & Research Centre, Mumbai P.V. Rao, Department of Endocrinology & Metabolism, Malla Reddy Institute of Medical Sciences, Hyderabad B.K. Sahay, Sahay’s Diabetes Center, Hyderabad Rakesh Sahay, Department of Endocrinology, Osmania Medical College and General Hospital, Hyderabad Banshi Saboo, DIA CARE - Diabetes Care & Hormone Clinic, Ahmedabad V. Seshiah, Distinguished Professor, The Tamil Nadu Dr. MGR Medical University, Chennai K.R. Narasimha Setty, Karnataka Institute of Diabetology, Bengaluru Nihal Thomas, Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore

KK Tripathi, Institute of Medical Sciences, Banaras Hindu University, Varanasi Vijay Viswanathan, MV Hospital for Diabetes, Chennai
Silver Bahendeka, Senior Consultant, Diabetes and Endocrinology, Kampala, Uganda Paresh Dandona, State University of New York, Buffalo, USA Md Fariduddin, Department of Endocrinology, BangabandhuSheikh Mujib Medical University, Bangladesh Satish K Garg, University of Colorado, Denver, USA Ved V Gossain, Michigan State University, Michigan, USA R G Naik, University of Pennsylvania, Philadelphia, USA K M Venkat Narayan, Department of Medicine and Epidemiology, Emory University, Atlanta, USA Dina Shresta, Norvic International Hospital and Medical College, Kathmandu, Nepal Noel Somasundaram, National Hospital of Sri Lanka, Colombo, Sri Lanka Devjit Tripathi, University Hospital in San Antonio, Texas, USA
Aims and Scope
International Journal of Diabetes in Developing Countries targets a readership consisting of clinicians, research workers, paramedical personnel, nutritionists and health care personnel working in the field of diabetes. Original research work and reviews of interest to the above group of readers is considered for publication in the journal. The journal has a goal of serving as an important resource material in diabetes for its readers, mainly in the developing world.
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© 2021 Research Society for Study of Diabetes in India
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International Journal of Diabetes in Developing Countries is published 4 times a year. Volume 41 (4 issues) of will be published in 2021.
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International Journal of Diabetes in Developing Countries
Volume 41 · Supplement 1 · January–March 2021

Diabetes Mellitus and Heart Failure: A Consensus Statement S1

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Disclaimer: This Consensus Statement on Diabetes and Heart failure was prepared by Research Society for the Study of Diabetes in India (RSSDI) and is a proprietary work of RSSDI as a service to the medical profession. The views expressed and stated in this publication are the independent views of the authors and not of Abbott. Abbott has got limited license to share this guidance with relevant stakeholders within the Indian healthcare ecosystem. This statement is being disseminated purely for information and awareness of healthcare professionals and is not meant for patients. Healthcare professionals should exercise their own professional judgement while referring to these guidelines. While every effort is made to ensure the accuracy of the contents hereof, any liability for error, omission or consequence arising from the use of this information is hereby disclaimed. The contents herein do not constitute or imply an endorsement, sponsorship or recommendation of any kind by Abbott.

Diabetes Mellitus and Heart Failure: A Consensus Statement
Primary Authors: Banshi Saboo1, Sanjay Agarwal2, AK Singh3 , Brij Makkar4, Rajeev Chawla5, Sujoy Ghosh6, Vijay Viswanathan ,7Sunil Gupta ,8Vasanth Kumar ,9Anuj Maheshwari 10
Affiliations 1 Diabetologist and Chairman, Diabetes Care & Hormone Clinic Dia-Care. Ahmedabad-15
National President, RSSDI
2 MD, FACE, Director, Aegle Clinic-Diabetes Care Head, Dept. of Medicine and Diabetes, Ruby Hall Clinic, Sr.Consultant in Diabetes & Medicine, Jehangir Hospital National Secretary, RSSDI
3 M.D., D.M (Endo) Consultant Endocrinologist GD Hospital & Diabetes Institute, Kolkata (India)
4 MD, FIAMS, FICP, FRCP(Glasg, Edin), FACP(USA), FACE(USA), FRSSDI Diabetologist & Bariatric Physician, Dr Makkar’s Diabetes & Obesity Centre A-5B/122, Paschim Vihar, New Delhi-110063
5 Director, North Delhi Diabetes Centre Hony Prof Jaipur National University, 180 Jai Apartment Sec-9 Rohini, New Delhi-110085
6 Dept of Endocrinology Institute of Post Graduate Medical Education and Research Kolkata Room 9B. 4th floor. Ronald Ross building Institute of Post Graduate Medical Education and Research Kolkata 244 A J C Bose Road Kolkata 700020
7 No.4, West Mada Church Street Royapuram, Chennai - 600 013 Tamilnadu, India
8 Managing Director, Sunil’s Diabetes Care n’ Research Centre Pvt.Ltd 42, Lendra Park, Ramdaspeth, Nagpur-440010 Maharashtra India
9 Senior Consultant, Apollo Hospitals. Hyderabad, India
10 Vice President Research Society for Study of Diabetes in India (RSSDI) Professor and Head, Department of Medicine, BBD University, Lucknow Governor, American College of Physicians, India Chapter


© Research Society for Study of Diabetes in India 2021

Corresponding Author: Sanjay Agarwal1aSecretary, RSSDI; Pune Address: Aegle Clinic - Diabetes Care, A-11 Narsimha Housing Society, 194 Boat Club Road, Pune - 411011
Email: [email protected]
Extended Panel of Experts: 1AK Das 2Anand Moses 3Anant Nigam, 4Bikash Bhattacharjee 5HB Chandalia 6JJ Mukherjee 7J. K. Sharma 8L.Sreenivasa Murthy 9Mangesh Tiwaskar 10Neeta Deshpande 11Pratap Jethwani 12Rakesh Sahay 13Rajiv Kovil 14Sanjay Kalra 15Sanjeev Phatak 16Sanjay Reddy 17Shalini Jaggi 18Shashank Joshi 19Siddarth Das 20Sudhir Bhandari 21S.V Madhu 22SR Aravind 23V. Mohan 24Vijay Panikar

Word count: 6995 No. of figures: 3 No. of tables: 4

Int J Diabetes Dev Ctries (Jan-Mar 2021) 40 (Supp 1):S1-S41


Based on the clinical and epidemiological data, it has been documented that in addition to myocardial infarction (MI) and atherosclerosis-related cardiovascular diseases (CVD), heart failure (HF) is a potential contributor to the morbidity and mortality in patients with diabetes.(1) Type 2 diabetes mellitus (T2DM) is a distinguished predisposing factor for HF(1). The pathophysiology of these two conditions is closely associated. Timely identification and immediate suitable intervention generate to a better outcome. Majority of patients with coexisting T2DM and CVD along with other co-morbidities (e.g., atherosclerotic CVD, HF, chronic kidney disease (CKD), and obesity) augments the need of a specific approach in the selection of appropriate antidiabetic drugs.(2) The present consensus document provides an evidence-based assessment on risk factors, prognosis, and proper management to reduce the morbidity and mortality. It also discusses the management strategies for patients of HF with concomitant T2DM.
Epidemiology of diabetes mellitus and heart failure: Numerous studies have shown that pre-diabetes is associated with a high risk of HF and suggest an age-adjusted hazard ratio (HR) between 1.2 and 1.7 in different populations of patients with impaired fasting glucose. However, the results are conflicting and hence, no agreement could be established among all studies. As a matter of fact, the risk of developing HF in subjects with prediabetes is lower than in subjects with diabetes.(3)
In a systematic review, consisting of 4,549,481 patients with T2DM, documented a 14.9% prevalence of HF, 14.6% of angina, and 10% of myocardial infarction (MI) in patients with T2DM (4). Additionally, in a Swedish and Spanish HF registry data, the prevalence of T2DM in patients with HF were 24% and 45.3% respectively (5). Similarly, in a study which recruited 1082 patients with HF, 490 (45.3%) constituted concomitant diabetes patient. In course of follow-up, it was observed that a total of 151 patients (30.8%) with T2DM died, and 197 patients (40.2%) with T2DM were readmitted because of HF. Increased all-cause mortality (ACM) [hazard ratio (HR) 1.49]; and readmissions [HR 1.39] in T2DM was significantly associated in that study (6). Further, a study by Parry et al., revealed that glycated hemoglobin (HbA 1c) < 6 % (HR 1. 60) as well as HbA1c > 10% (HR 1.80) were independently associated with the risk of HF(6).


Int J Diabetes Dev Ctries (Jan-Mar 2021) 40 (Supp 1):S1-S41

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International Journal of Diabetes in Developing Countries