This handout is for acute hf — diabetic cardiomyopathy. Your care team identified this based on: dyspnea / orthopnea / edema in t2dm ≥10 yr without obstructive cad or long-standing htn → diabetic cardiomyopathy pathway.
Other reasons your team may use this plan: nt-probnp elevated + hba1c >9% + concurrent diabetic microvascular complications (retinopathy/nephropathy/neuropathy); echo grade ii/iii diastolic dysfunction + lvh + impaired gls (global longitudinal strain) in diabetic patient — early diabetic cardiomyopathy; cardiac mri diffuse subendocardial lge pattern + increased t1/ecv in diabetic patient with hf.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| empagliflozin | 10 mg PO daily from day 1 of admission | PO | daily lifelong | EMPULSE (Voors Nat Med 2022 PMID 35347356) — in-hospital initiation safe + 36% improvement in primary clinical benefit hierarchy at 90 d in HFrEF + HFpEF, diabetic + non-diabetic; EMPEROR-Reduced PMID 32865377; EMPEROR-Preserved PMID 34449189 |
| dapagliflozin | 10 mg PO daily | PO | daily lifelong | DAPA-HF (McMurray NEJM 2019 PMID 31535829) HFrEF; DELIVER (Solomon NEJM 2022 PMID 36027570) HFpEF; class effect demonstrated |
| semaglutide | 0.25 mg SC weekly × 4 wk → titrate to 2.4 mg weekly (HFpEF + obesity) or 1 mg weekly (T2DM) | SC | weekly | STEP-HFpEF (Kosiborod NEJM 2023 PMID 37877559) — semaglutide 2.4 mg weekly in obese HFpEF: 5%+ weight loss, KCCQ + 6MWD improvement; SELECT cardiovascular benefit independent of T2DM |
| metformin | 500 mg PO BID, titrate to 1000 mg BID | PO | BID | ADA 2024 first-line oral; HOLD during acute illness (lactic acidosis risk); restart when stable + eGFR ≥30 |
| insulin glargine | 0.2–0.3 U/kg SC daily basal + correctional regular insulin scale | SC | daily basal | Basal-bolus regimen for inpatient hyperglycemia; target 140–180 mg/dL per ADA inpatient; avoid sliding-scale-only |
| furosemide | 40 mg IV (or 2.5x outpatient dose for chronic users — DOSE-AHF PMID 21366472) | IV/PO | q12h titrate to UOP 100–200 mL/h | Standard ADHF decongestion; DOSE-AHF — high-dose strategy improves dyspnea more than low; transition to PO when stable |
| sacubitril-valsartan | 24/26 mg PO BID titrate to 97/103 mg BID | PO | BID | PIONEER-HF (Velazquez NEJM 2019 PMID 30403955) — in-hospital initiation safe + reduces NT-proBNP more than enalapril; ACC/AHA 2022 HF Class I in HFrEF |
Plan: Diabetic cardiomyopathy ADHF — SGLT2i-first regimen (EMPULSE PMID 35347356 + ACC/AHA 2022 HF + ADA 2024)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Cardiology + endocrinology co-clinic; STRONG-HF–style up-titration weekly × 4; HbA1c at 3 mo; ophthalmology + nephrology follow-up; semaglutide initiation if HFpEF + obesity; CGM consideration
Guideline: 2022 ACC/AHA HF Guideline (Heidenreich) + ADA 2024 Standards + EMPULSE + DAPA-HF + STEP-HFpEF + SAVOR-TIMI 53