Does diabetes cause heart failure? Diabetes is a risk factor for heart failure, a condition in which the heart cannot pump enough blood for the body's needs. The American Diabetes Association's (ADA) Standards of Care in Diabetes—2026 say heart failure is at least twofold more common in people with diabetes. Early signs include shortness of breath, swelling in the legs, and fatigue.
Key takeaways
- ADA's 2026 Standards say diabetes is a risk factor for heart failure, which is at least twofold more common in people with diabetes.
- Heart failure does not mean the heart has stopped; it means the heart is not pumping as well as it should.
- The American Heart Association says shortness of breath, swelling, fatigue, persistent cough, and sudden weight gain are common warning signs.
- ADA suggests doctors consider a blood test called BNP or NT-proBNP to find early heart failure risk in adults with diabetes.
- CDC says early diagnosis and treatment can help relieve symptoms and stop or delay heart failure from getting worse.
Diabetes and Heart Failure: The Short Answer
- Diabetes raises the risk. ADA calls diabetes a risk factor for heart failure, and the CDC says people with diabetes are more likely to have it.
- Several paths lead there. Coronary artery disease, high blood pressure, and obesity often come first. ADA also says people with diabetes can develop heart muscle problems even without blocked arteries.
- It can be caught early. ADA describes symptom-free early stages and suggests doctors consider a blood test to look for them.
- It is manageable. The American Heart Association (AHA) says heart failure usually has no cure, but many people live full lives with medicines and a healthy lifestyle.
What Is Heart Failure?
The National Heart, Lung, and Blood Institute (NHLBI) says heart failure, also called congestive heart failure, develops when the heart does not pump enough blood for the body's needs. This can happen if the heart cannot fill with enough blood, or if it is too weak to pump properly. NHLBI says the term does not mean the heart has stopped, but heart failure is a serious condition that needs medical care.
Heart failure can come on suddenly or develop slowly over time. NHLBI says it may not cause symptoms right away, but eventually people may feel tired and short of breath and notice fluid buildup in the lower body, stomach, or neck.
Why Diabetes Raises Heart Failure Risk
ADA's 2026 Standards describe several routes from diabetes to heart failure:
- Blocked heart arteries. ADA says coronary artery disease is a major risk factor and a cause of heart muscle injury that leads to heart failure. See how diabetes affects the heart for how plaque builds up.
- High blood pressure and extra weight. ADA says overweight, obesity, and high blood pressure often come before a type of heart failure in which the heart muscle is stiff (heart failure with preserved ejection fraction). The AHA says high blood pressure makes the heart pump harder, and over time its chambers can grow larger and weaker.
- Heart muscle changes without blocked arteries. ADA says people with diabetes are at risk for structural heart disease and a weak-pumping type of heart failure even when they do not have blocked coronary arteries. This is sometimes called diabetic cardiomyopathy.
- Shared risk with the kidneys. ADA says heart disease, heart failure, and chronic kidney disease often share the same metabolic causes, and that all three become more common as A1C rises. See how diabetes affects the kidneys.
The AHA lists type 2 diabetes among the risk factors that greatly increase heart failure risk, because people with diabetes tend to get high blood pressure and cholesterol-related artery disease. Other AHA risk factors include coronary artery disease, metabolic syndrome, smoking, obesity, and age over 65.
Heart Failure Warning Signs
| Sign | What you might notice | Why it happens (per AHA) |
|---|---|---|
| Shortness of breath | Breathless with activity or at rest, or waking at night short of breath; needing extra pillows to breathe | Fluid backs up and leaks into the lungs |
| Cough or wheezing | A lasting cough, sometimes with white or pink mucus | Fluid builds up in the lungs |
| Swelling (edema) | Swollen feet, ankles, legs, or stomach | Blood backs up in the veins and fluid moves into tissues |
| Tiredness | Feeling tired all the time; everyday tasks feel hard | The heart cannot pump enough blood to meet the body's needs |
| Low appetite or nausea | Feeling full or sick to your stomach | The digestive system gets less blood |
| Confusion | Memory loss or disorientation | Changes in substances such as sodium in the blood |
| Fast heart rate | Palpitations, a racing or throbbing heart | The heart beats faster to make up for weak pumping |
| Weight change | Sudden weight gain or loss | Fluid retention, or poor absorption of nutrients |
The AHA says to report one or more of these symptoms to your healthcare professional, even if you have not been diagnosed with a heart problem, and to ask for an evaluation of your heart. Leg swelling has many causes, so our guide to whether diabetes can cause leg swelling covers the other possibilities. A fast heart rate can also come from diabetes-related nerve damage; see diabetes and high heart rate.
Get checked right away if symptoms get worse quickly. The AHA's heart failure self-check plan says weight gain of more than 2 to 3 pounds in 24 hours or 5 pounds in a week, worsening swelling, or not being able to lie flat means you should call your physician or 911 to be evaluated right away. Call 911 for chest pain or pressure, or shortness of breath, that could be a heart attack; NIDDK lists both as heart attack warning signs.
Can Heart Failure Be Found Early?
ADA's 2026 Standards say adults with diabetes are at increased risk of heart changes that cause no symptoms yet (stage B heart failure) and of symptomatic heart failure (stage C). ADA says people with diabetes are at particularly high risk of moving from the early, symptom-free stages to the symptomatic stages.
To catch this earlier, the Standards say doctors should consider screening adults with diabetes with a natriuretic peptide blood test (B-type natriuretic peptide, BNP, or N-terminal pro-BNP, NT-proBNP). If the result is abnormal in someone without symptoms, ADA recommends an echocardiogram, an ultrasound that shows how well the heart pumps. The CDC also names the echocardiogram as a test that shows how thick the heart muscle is and how well it pumps.
Ask your care team whether a BNP or NT-proBNP test makes sense for you. Bring a list of any breathlessness, swelling, or tiredness you have noticed, with dates.
How Heart Failure Is Managed With Diabetes
The CDC says heart failure tends to get worse over time, but early diagnosis and treatment can help relieve symptoms and stop or delay it from getting worse. NHLBI says treatment such as healthy lifestyle changes, medicines, some devices, and procedures can help many people have a higher quality of life.
ADA's 2026 Standards name several medicine classes for people with diabetes who have early or established heart failure, including SGLT2 inhibitors and GLP-1 receptor agonists with proven heart failure benefit, alongside standard heart medicines. ADA also recommends that care include a cardiovascular specialist. Which medicine, if any, is a decision for your prescriber. Do not start, stop, or change a medicine on your own.
The AHA says your care team will tell you which symptoms to track. The most common are blood pressure, heart rate, weight, and fluid intake. Report any sudden changes.
Lowering Your Heart Failure Risk
Because coronary artery disease, high blood pressure, and obesity often come before heart failure, the steps that protect your arteries also protect your heart muscle:
- Work with your care team on your A1C, blood pressure, and cholesterol goals. See blood pressure targets for diabetics.
- Stop smoking, which the AHA lists as a heart failure risk factor.
- Move most days. The AHA recommends at least 150 minutes of moderate activity a week for overall heart health; ask your doctor what is safe for you.
- Ask about kidney tests, since heart and kidney disease often travel together.
Our guide to lowering heart disease risk with diabetes turns these into weekly steps.
Frequently Asked Questions
Does diabetes cause heart failure?
Diabetes is a risk factor for heart failure. ADA's 2026 Standards say heart failure is at least twofold more common in people with diabetes than in people without it. Coronary artery disease, high blood pressure, obesity, and direct changes to the heart muscle all play a part.
What are the first signs of heart failure in a diabetic?
The American Heart Association lists shortness of breath, a lasting cough or wheezing, swelling in the feet, ankles, or legs, tiredness, low appetite, a fast heart rate, and sudden weight gain. Report any of these to your healthcare professional and ask for a heart evaluation.
What is diabetic cardiomyopathy?
It is a name for heart muscle changes linked to diabetes. ADA's 2026 Standards say people with diabetes can develop structural heart disease and a weak-pumping type of heart failure even without blocked coronary arteries. Your doctor can check heart muscle function with an echocardiogram.
Is there a test for heart failure risk with diabetes?
Yes. ADA's 2026 Standards say doctors should consider screening adults with diabetes with a natriuretic peptide blood test, BNP or NT-proBNP. If the result is abnormal in someone without symptoms, ADA recommends an echocardiogram. Ask your care team whether this test is right for you.
Can heart failure from diabetes be reversed?
The American Heart Association says heart failure usually has no cure, but many people live full lives when it is managed with medicines and a healthy lifestyle. The CDC says early diagnosis and treatment can help relieve symptoms and stop or delay it from getting worse.
Which diabetes medicines help with heart failure?
ADA's 2026 Standards name SGLT2 inhibitors and GLP-1 receptor agonists with proven heart failure benefit for some people with type 2 diabetes, along with standard heart medicines. Whether any of these fits you is a decision for your prescriber. Do not change your medicines without talking to them.
References
- American Diabetes Association Professional Practice Committee for Diabetes. "10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026." Diabetes Care. 2026;49(Suppl. 1):S216–S245.
- Centers for Disease Control and Prevention. "Diabetes and Your Heart." Accessed October 2026.
- National Heart, Lung, and Blood Institute. "What Is Heart Failure?" Accessed October 2026.
- American Heart Association. "Warning Signs of Heart Failure." Accessed October 2026.
- American Heart Association. "Causes and Risks for Heart Failure." Accessed October 2026.
- American Heart Association. "What is Heart Failure?" Accessed October 2026.
- National Institute of Diabetes and Digestive and Kidney Diseases. "Diabetes, Heart Disease, & Stroke." Accessed October 2026.
- American Heart Association. "Cardiovascular Disease and Diabetes." Accessed October 2026.
Next Steps
If you have noticed breathlessness, swelling, or unusual tiredness, write down when it started and bring the list to your next visit. Ask whether a BNP or NT-proBNP test is right for you.
For adults with type 2 diabetes or prediabetes who want lifestyle education alongside clinical care, the Done With Diabetes™ program, a holistic approach to type 2 diabetes, organizes daily learning about meals, movement, sleep, and stress. It does not diagnose or treat heart failure or diabetes, interpret test results, change medicines, or replace your care team.