Diabetes Mellitus ( Dm )

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Diabetes mellitus (DM) exists in 29.1 million people, or 9.3% of the United States population, and of these 29.1 million people, 65% will die from a form of heart disease. DM adds incremental risk to the development or subsequent exacerbation of heart failure; this holds true even after adjustment of common risk factors such as ischemic heart disease and hypertension. Furthermore, the prevalence of heart failure in patients with DM is between 10% and 22%; this is four times higher than the general population.
Controlling blood glucose has been widely accepted as a method to reduce risk of atherosclerotic cardiovascular events and new-onset heart failure; although this observational relationship exists, no evidence from randomized controlled trials illustrates that improved glycemic control modifies risk. Many of the antihyperlipidemic agents, namely thiazolidinediones, dual peroxisome proliferator-activated receptor agonists, sulfonylureas, and insulin may cause adverse events such as increased plasma volume, exacerbation of heart failure, dysregulation of myocardial metabolism, and worsening of left ventricular function; therefore, a clinical concern exists with prescribing agents that may lead to morbidity and mortality.
The United States Food and Drug Administration has set standards on new diabetic drugs’ safety in regards to major adverse cardiovascular events, but heart failure events are not included in this safety requirement. Moreover, the rates of heart failure

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