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The Two-Way Relationship Between Diabetes and Heart Failure: How Each Worsens the Other

RPEP-148242026Balagopalan, Jayagopal Pathiyil; Bansal, Sandeep; Bhattacharyya, Arpandev; Zargar, Abdul Hamid; Dani, Sameer; Taraphder, Abhijit; Almeida, Alan; Deka, Nilakshi; Jain, Sanjay; Swami, Onkar C
evidence
The takeaway

A review examines how diabetes causes heart failure through metabolic mechanisms and how heart failure induces new-onset diabetes through insulin signaling disruption.

Bidirectional damage

Diabetes drives heart failure through metabolic injury; heart failure triggers new diabetes through insulin disruption

What the researchers found

Diabetes and heart failure have a bidirectional pathophysiological relationship where each condition actively promotes and worsens the other.

Why it matters

With both conditions rising globally, understanding their mutual reinforcement is critical for developing effective treatment strategies that address both simultaneously.

How the study worked

Narrative review of the epidemiological, mechanistic, and clinical interplay between diabetes mellitus and heart failure.

What this study cannot tell us

Narrative review — comprehensive but selective; the complexity of bidirectional pathophysiology makes specific therapeutic recommendations difficult.

How to read the evidence

Narrative review — synthesizes mechanistic and clinical evidence for the bidirectional diabetes-HF relationship.

When this study was published

Published 2026 in Diabetology International.

The bigger picture

The diabetes-heart failure nexus exemplifies why treating metabolic disease requires integrated approaches rather than siloed specialty care.

Questions still open

  • Should all heart failure patients be screened for diabetes and vice versa?
  • Can early metabolic intervention prevent the diabetes-heart failure cycle?

Common questions

Can heart failure cause diabetes?
Yes — heart failure disrupts insulin signaling in the body, which can lead to new-onset type 2 diabetes. This creates a vicious cycle where each condition makes the other worse.
What treatments help both diabetes and heart failure?
GLP-1 receptor agonists and SGLT2 inhibitors are two drug classes that improve both blood sugar control and heart failure outcomes, making them ideal for patients with both conditions.

Read the original research

Concurrent diabetes and heart failure: revisiting epidemiological and clinicopathological interplay.

Diabetology international, 17(1), 12

View on PubMed ↗Publisher’s paper ↗

Citation

Balagopalan, Jayagopal Pathiyil; Bansal, Sandeep; Bhattacharyya, Arpandev; Zargar, Abdul Hamid; Dani, Sameer; Taraphder, Abhijit; Almeida, Alan; Deka, Nilakshi; Jain, Sanjay; Swami, Onkar C. (2026). Concurrent diabetes and heart failure: revisiting epidemiological and clinicopathological interplay.. Diabetology international, 17(1), 12. https://doi.org/10.1007/s13340-025-00855-5