In general, people with diabetes who develop heart failure can continue therapy for their diabetes. However, some oral hypoglycaemic drugs are contraindicated in the presence of heart failure, i.e. glitazones and metformin.

Metformin can cause a rare and fatal toxic effect known as lactic acidosis, which is caused by accumulation of lactic acid more rapidly than it can be metabolised. Cardiac disease increases anaerobic metabolism and so puts people with heart failure at higher risk of lactic acidosis.

When used alone or in combination with other antidiabetic agents, glitazones can cause fluid retention, which in turn may lead to or exacerbate heart failure. For this reason, any person with diabetes should be monitored regularly for any deterioration in cardiac status.

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