HF with preserved ejection fraction (HFpEF) as the predominant and underrecognized heart failure phenotype in type 2 diabetes: evidence from the DIABET-IC study
Authors' conclusion
HFpEF is the most frequent HF phenotype in the T2D population, with outcomes comparable to HFrEF yet frequently underdiagnosed and undertreated. Improved screening strategies and broader adoption of evidence-based therapies-particularly SGLT2 inhibitors-are urgently needed for this high-risk population.
Study context
- Population
- Patients with T2D recruited across 58 Spanish centers, followed for three years490 with heart failure (HF) at baseline
- Participants
- 1,517 patients
- Comparison
- HFpEF vs HF with reduced ejection fraction (HFrEF)
Methodological detailsnationwide, multicentre (58 Spanish centers)
- Nationwide
- Multicentre (58 Spanish centers)
Primary result
As reported in the abstract
HF phenotype distribution at baseline
Further findings
Incident HF phenotype during follow-up
- HFpEF share of new HF cases
- 46.6%
- Progressed to HFrEF
- 4.7%
Mortality, HF hospitalizations and acute coronary syndromes · follow-up
- Mortality similarly elevated in both phenotypes; HF hospitalizations tended to be higher in HFrEF; acute coronary syndromes more frequent in HFpEF
Treatment patterns
- HFrEF more often received guideline-directed therapies; HFpEF: greater uptake of SGLT2 inhibitors over time, limited use of GLP-1 RA
HFpEF with natriuretic peptide levels below diagnostic thresholds
- HFpEF patients with natriuretic peptides below diagnostic thresholds
- > 20%
Original publication
HFpEF as the predominant and underrecognized heart failure phenotype in type 2 diabetes: evidence from the DIABET-IC study. Cardiovasc Diabetol. Published 3 November 2025. doi:10.
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