Topic
Date published
12/11/2026
In this group diabetes is common, often silent, and easy to miss when every appointment is about the heart. A recent patient reminded me how much one routine blood test can change.
A routine review, an unexpected finding
Mrs A (not her real name) lives with heart failure and came in for her routine review. She felt reasonably well. Her notes showed no recent check for diabetes, so I added an HbA1c test, which shows average blood sugar over the past two to three months, to her bloods. It came back in the diabetes range. She had no idea.
Her first worry was not her blood sugar. “I already have so many tablets and appointments. How am I supposed to manage another condition?” She was anxious about:
- more visits to the surgery and the hospital
- conflicting advice from different clinics
- more tablets on top of her heart medicines
- whether the new diagnosis meant her heart was getting worse
These concerns are common, and they are fair. For many people, care for several long-term conditions feels split into pieces.
Why this matters
Mrs A is not unusual. In four major heart failure trials (CHARM, EPHESUS, PARAMOUNT and PARADIGM-HF), around 3 in 10 participants had diabetes that had never been diagnosed.¹⁻⁴
Diabetes in heart failure is linked to more hospital admissions and poorer survival. Every missed diagnosis is a missed chance to act sooner.
One plan, not two
The reassuring news for Mrs A was that her heart and her diabetes can often be managed together.
Some diabetes medicines also protect the heart and kidneys, while others are used with more care in heart failure, so her care team chose her treatment with both in mind.
Lifestyle advice is largely the same for both conditions: staying active within safe limits (cardiac rehabilitation can help), eating less salt, keeping to a healthy weight, not smoking and keeping alcohol low.
Just as important, we agreed one combined review each year, with one set of bloods and one medicines plan. Her relief was obvious. A new diagnosis did not have to mean a new set of appointments.
Joined-up care and our research
In the Multiple Long-Term Conditions (MLTC) theme of NIHR ARC East Midlands, we develop and test approaches that help people with more than one long-term condition live better and receive more joined-up care.
Our Diabetes Model of Care Toolkit shares a nationally recognised integrated approach to improving diabetes outcomes through co-ordinated primary, secondary and community care. It also covers managing conditions such as cardiovascular and kidney disease alongside diabetes.
Mrs A’s experience shows why joined-up care also matters for people whose first long-term condition is something else, such as heart failure.
Look for it, and you will find it
My message is simple: do not wait for symptoms.
If you work in healthcare:
- Offer a blood test for diabetes (HbA1c or fasting glucose) when someone is diagnosed with heart failure, and at their regular reviews.
- Remember that HbA1c can be harder to interpret in people with anaemia or advanced kidney disease.
- Treat the person, not the list of conditions: combine reviews and medicines wherever possible.
If you live with heart failure, you can ask your care team whether you have had a check for diabetes.
Mrs A’s diabetes was there all along. It only took someone to look.
References
- Granger CB, et al. Lancet 2003;362:772.
- Pitt B, et al. N Engl J Med 2003;348:1309.
- Solomon SD, et al. Lancet 2012;380:1387.
- McMurray JJV, et al. N Engl J Med 2014;371:993.