Background: Heart failure (HF) is one of the most common and morbid complications of T2D. Prompt recognition of early signs of HF may avert HF hospitalization and may also impact T2D meds (e.g., TZDs or possibly SGLT2i). We determined the rate and factors associated with HF diagnosis in T2D patients with evidence of volume overload requiring loop diuretics.

Methods: DCR is a U.S. registry of outpatient T2D patients from 3074 cardiology, endocrinology, and primary care providers. Among T2D patients receiving loop diuretics, we examined the rate of documentation of HF. We excluded patients with chronic liver disease, as they may have a non-HF indication for loop diuretics.

Results: Among 931,361 adults with T2D, 215,957 (23%) were on a loop diuretic of whom 110,809 (51%) had documentation of HF. Patients seen by cardiologists and PCPs were more likely have HF documented vs. endocrinologists (52% and 50% vs. 22%; p<0.001). Younger age, male sex, lower BMI, afib, CKD, and CAD were associated with greater odds of HF diagnosis (Figure).

Conclusions: Among U.S. outpatients with T2D, 23% had evidence of volume overload of whom half had a diagnosis of HF. While there may be non-HF indications for loop diuretics, our data suggest that a substantial proportion of T2D patients may have unrecognized HF and therefore could be missing therapies that could alter the clinical course of HF.


S.V. Arnold: None. M.N. Kosiborod: Consultant; Self; Amgen Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Eisai Co., Ltd., GlaxoSmithKline plc., Glytec, LLC, Intarcia Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novartis AG, Novo Nordisk A/S, Sanofi. Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc. P. Jones: None. M.H. Beasley: None. A. Goyal: None. J.M. Cordova: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. G.C. Fonarow: Consultant; Self; Abbott, Amgen Inc., Bayer US, Janssen Pharmaceuticals, Inc., Medtronic, Novartis Pharmaceuticals Corporation. L.J. Seman: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at