In this systematic review, metformin was associated with the best outcomes.
The combination of diabetes and heart failure imposes a greater mortality burden than either condition alone. Nonetheless, we know very little about the association between antidiabetic drugs and outcomes in patients with both conditions. In a systematic review, Canadian investigators identified eight studies (only 1 was a randomized trial) that assessed the risk for mortality or hospital admission in heart failure patients taking antidiabetic agents. Four studies evaluated the effect of insulin (9104 patients); three examined metformin (3327 patients); four evaluated thiazolidinediones (3409 patients); and two studies compared sulfonylureas with other agents (8918 patients).
In three of four studies, insulin was associated with an increased…