The double burden: type 1 diabetes and heart failure—a comprehensive review

Table 3 Pharmacological and non-pharmacological treatment of heart failure in patients with diabetes

Non-pharmacological	• Cardio-healthy diet low in salt (< 3 g per day) • Regular physical exercise (combination of aerobic and muscle strength) • Smoking cessation and reduced alcohol consumption • Management of cardiovascular and non-cardiovascular comorbidities (hypertension, obesity, kidney disease, lipid disorders, etc.) • Cardiac rehabilitation for eligible patients • Avoiding medications that may lead to decompensating (NSAIDs, COX-2 inhibitors, etc.) • Vaccination (influenza, pneumonia, COVID-19, tetanus) • Monitoring of weight and blood pressure, preferably daily • Patient and/or caregiver education • Prevention of hypoglycemia

	HFrEF (≤ 40%)	HFmrEF (41–49%)	HFpEF (≥ 50%)
Pharmacological	ACEI/sacubitril/ valsartan Β-blockers MRAs SGLT2i*	ACEI/sacubitril/ valsartan Β-blockers MRAs SGLT2i*	Comorbidities treatment + SGLT2i*

^* No randomized clinical trials have evaluated the effect of treatment with SGLT2i in HF and DM1
NSAIDs Nonsteroidal Anti-Inflammatory Drugs, Cox-2 inhibitors cyclooxygenase-2, HF heart failure; HFrEF heart failure with reduced ejection fraction, HFmrEF heart failure with mildly reduced ejection fraction, HFpEF heart failure with preserved ejection fraction, ACEI angiotensin-converting enzyme inhibitors, MRAs mineralocorticoid receptor antagonists, SGLT2i sodium-glucose cotransporter 2 inhibitors

ISSN: 1475-2840