“Glocalization” of concomitant heart failure and diabetes in Asia

Asia has witnessed significant economic growth and urbanization in the past few decades. In parallel, this has increased the burden of diabetes, obesity, and heart failure (HF). Emerging data has shown that between 40% and 57% of Asian patients with HF have concomitant diabetes. Compared with their Caucasian counterparts, Asian patients with HF have a threefold higher burden of diabetes, are a decade younger, have a lower body mass index, and have greater comorbidity burden. In Asia, there are important differences in clinical correlates and left ventricular remodeling patterns associated with diabetes between HF with reduced ejection fraction (HFrEF) and HF with preserved ejection (HFpEF). Irrespective of the HF subtype, diabetes portends worse quality of life and clinical outcomes. Simultaneously, evidence for a lean diabetic phenotype in HF is accumulating in this region. Given the rich ethnic and regional diversity in Asia, one size certainly does not fit all here. Tailoring therapies and public health policies which cater to these distinct Asian phenotypes is essential for strategic management of concomitant diabetes and HF. This review will explore the epidemiology, clinical correlates, and the unique characteristics of concomitant diabetes in both HFrEF and HFpEF in Asia, with emphasis on the lean diabetic phenotype of HF.