Patients who suffer from type 2 diabetes and coronary heart disease could be in worse shape than doctors previously thought, say the authors of a new study published in the journal Diabetes Care.

The EXAMINE trial study examined the health of nearly 5,400 people with type 2 diabetes at almost 900 institutions around the world. The people from that group who were then hospitalized for congestive heart failure had a 24 to 28 percent chance of dying within 18 months, depending on whether they took the drug alogliptin or a placebo. meaning people with type 2 diabetes are five times to more likely to die when they experience heart failure than when they don’t.

Additionally, type 2 diabetes patients were found to be two to three times more likely to develop heart disease in the first place (possibly due to similar causes of the two diseases, and possibly because insulin medication could damage the heart).

The study was spearheaded by William B. White, MD, of the University of Connecticut's Calhoun Cardiology Center. In a review of the trial published in the New England Journal of Medicine in 2013, health outcomes for the two groups didn’t appear significantly different. But the new results show a different story.

 "It's a very dramatic result," White said in a statement. "A person with type 2 diabetes requiring hospitalization for heart failure in the EXAMINE trial was a harbinger of a very poor outcome."

He added that the trial outcomes don’t mean all people with type 2 diabetes will face heart failure, but they might need more aggressive care to prevent it than previously thought.

Physicians from Harvard Medical School and Brigham and Women’s Hospital have joined White and the study authors to dive deeper into the research results. They’ll look at ways to detect the risk of heart failure in type 2 diabetes patients earlier.