Diabetes treatment does not differ overall between patients with or without heart failure.

• Metformin is the first choice, unless in the case of severe renal insufficiency (GFR < 30 ml/min, risk of lactic acidosis).
• In every heart failure patient there is usually an indication for a SGLT-2 inhibitor.
• In addition, preference is given to a glucagon-like peptide-1 (GLP-1) receptor agonist (e.g. Trulicity, Victoza, Byetta, Ozempic, etc.), especially in the context of morbid obesity. Recent data show a remarkable improvement in quality of life in patients with obesity and HFpEF.
• Due to increased risk of salt and water retention:
  • Avoid thiazolidinediones (glitazones) (pioglitazone, Actos).
  • Glinidines (repaglinidine, Novonorm) to be used with caution.
  • Insulin, sulfonylureas, DPP-4 inhibitors should be used with some caution.
• Hypoglycemic episodes should be avoided as they negatively affect the prognosis.