May 21 - May 24 2022, Madrid, Italy. The Heart Failure Association (HFA) of the European Society of Cardiology works to improve quality of life and longevity through better prevention, diagnosis and treatment of heart failure.
At Heart Failure Congress 2022, our keynote speaker Dr. Professor G. Fazio illutrated how Glunovo Holter system allows the specialist to assess the glycaemic trend in its dynamism, capturing moments of variability that are often detrimental and predictive of cardiovascular risk.
Recently the guidelines of EACP reported a prevalence of diabetes mellitus in patients with diastolic heart failure (HFpEF) of 31%.
Tool: Glunovo CGM
Glunovo® is a transdermal device capable of detecting and storing the concentration of glucose in the abdominal interstitial fluid 480 times a day for up to 14 consecutive days. It is a new generation system for the continuous monitoring of blood glucose.
In this study we used Glunovo® to evaluate the glycaemic variability in HFpEF
100 patients with HFpEF admitted to 4 Italian centres were enrolled consecutively. Glunovo® was applied to each enrolled patient for 7 days, taking a total of 3360 punctual glucose measurements for each patient in the abdominal interstitial fluid. Inclusion criteria: signs or symptoms of congestive heart failure; left ventricular function >55%; abnormal relaxation pattern of transmitral flow and an increased E/E’ ratio in tissue doppler of lateral left ventricular wall. We calculated for each patient the glycaemic variability and the incidence of hyperglycaemia and hypoglycaemia. Glycaemic variability refers to a blood glucose value of ≥ 200 mg / dL or ≤ 59 mg / dL detected more than 3 times in a day for at least 4 days. Exclusion criterion: presence of diabetes diagnosis. Overall, 43 males and 57 females were enrolled with a mean age of 69.3 years (39-87 years). All patients underwent a timely glucose measurement at admission which excluded the presence of hyperglycaemia. No potentially hyperglycaemic drugs were added to the treatment during the hospital stay. Continuous glucose monitoring was performed as an integral part of the hospitalization diagnostic routine.
In 94 of the 100 patients enrolled it was possible to conclude the analysis. A glycaemia ≥200 mg/dL was found in 53 patients (56%) while a high glycaemic variability was found in 51 patients (54%). A blood glucose value <59 mg/dl was found in 48 patients (51%). Only 5 times the estimated glycated Hb values were> 6.5%. 32 of the patients with glycemic variability performed an oral glucose load curve, that in all cases confirmed the diabete. No statistically significant differences were found based on age group or sex. A control group of 10 patients without HFpEF was tested with Glunovo® and a glycaemic variability in only 1 patient (10%).
Our experience suggests an incidence of hyperglycaemia and glycaemic variability more then 65% in patients affected by HFpEF. If our data were reproducible on a large scale, a so high prevalence of diabetes in patients with HFpEF cold explain the efficacy of SGLT-2 inhibitor and GLP-1 Agonist in this class of patients.
FIGURE1: Graphical reproduction of the glycaemic trend in two different patients with similar HBA1c and similar fast plasma glucose
FIGURE 2 : Graphical reproduction of estimated incidence of diabetes based on our analysis