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Impact of Improved Glycemic Control on Cardiac Function in Type 2 Diabetes Mellitus.
Circ Cardiovasc Imaging. 2016 Mar; 9(3):e003643.CC

Abstract

BACKGROUND

Patients with type 2 diabetes mellitus are at risk of heart failure. Specific therapeutic interventions for diabetic heart disease are still elusive. We aimed to examine the impact of improved glycemic control on left ventricular (LV) function in these patients.

METHODS AND RESULTS

A total of 105 subjects with type 2 diabetes mellitus (aged 54±10 years) and poor glycemic control received optimization of treatment for blood glucose, blood pressure, and cholesterol to recommended targets for 12 months. LV systolic and diastolic function, measured by LV global longitudinal strain (GLS) and septal e' velocities, were compared before and after optimization. At baseline, patients had impaired LV systolic (GLS -14.9±3.2%) and diastolic function (e' 6.2±1.7 cm/s). After 12 months, glycated hemoglobin (HbA1c) decreased from 10.3±2.4% to 8.3±2.0%, which was associated with significant relative improvement in GLS of 21% and septal e' of 24%. There was a progressively greater improvement in GLS as patients achieved a lower final HbA1c. Patients achieving an HbA1c of <7.0% had the largest improvement. The 15 patients whose HbA1c worsened experienced a decline in GLS. Patients who improved their HbA1c by ≥1.0% had a significantly higher relative improvement in e' than those who did not (32% versus 8%; P=0.003). Baseline GLS, decrease in body mass index, and treatment with metformin were additional independent predictors of GLS improvement.

CONCLUSIONS

Improvements in glycemic control over a 12-month period led to improvements in LV systolic and diastolic function. This may have long-term prognostic implications.

Authors+Show Affiliations

From the Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia (M.L., D.Y.L.); University of New South Wales, Sydney, New South Wales, Australia (M.L., V.W.W., D.Y.L.); Liverpool Diabetes Collaborative Research Unit, Ingham Institute, Liverpool, Sydney, New South Wales, Australia (V.W.W.); Department of Statistics, Macquarie University, Sydney, New South Wales, Australia (M.H.); and NHMRC CTC, University of Sydney, Sydney, New South Wales, Australia (M.H.). melissa@unsw.edu.au.From the Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia (M.L., D.Y.L.); University of New South Wales, Sydney, New South Wales, Australia (M.L., V.W.W., D.Y.L.); Liverpool Diabetes Collaborative Research Unit, Ingham Institute, Liverpool, Sydney, New South Wales, Australia (V.W.W.); Department of Statistics, Macquarie University, Sydney, New South Wales, Australia (M.H.); and NHMRC CTC, University of Sydney, Sydney, New South Wales, Australia (M.H.).From the Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia (M.L., D.Y.L.); University of New South Wales, Sydney, New South Wales, Australia (M.L., V.W.W., D.Y.L.); Liverpool Diabetes Collaborative Research Unit, Ingham Institute, Liverpool, Sydney, New South Wales, Australia (V.W.W.); Department of Statistics, Macquarie University, Sydney, New South Wales, Australia (M.H.); and NHMRC CTC, University of Sydney, Sydney, New South Wales, Australia (M.H.).From the Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia (M.L., D.Y.L.); University of New South Wales, Sydney, New South Wales, Australia (M.L., V.W.W., D.Y.L.); Liverpool Diabetes Collaborative Research Unit, Ingham Institute, Liverpool, Sydney, New South Wales, Australia (V.W.W.); Department of Statistics, Macquarie University, Sydney, New South Wales, Australia (M.H.); and NHMRC CTC, University of Sydney, Sydney, New South Wales, Australia (M.H.).

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26962125

Citation

Leung, Melissa, et al. "Impact of Improved Glycemic Control On Cardiac Function in Type 2 Diabetes Mellitus." Circulation. Cardiovascular Imaging, vol. 9, no. 3, 2016, pp. e003643.
Leung M, Wong VW, Hudson M, et al. Impact of Improved Glycemic Control on Cardiac Function in Type 2 Diabetes Mellitus. Circ Cardiovasc Imaging. 2016;9(3):e003643.
Leung, M., Wong, V. W., Hudson, M., & Leung, D. Y. (2016). Impact of Improved Glycemic Control on Cardiac Function in Type 2 Diabetes Mellitus. Circulation. Cardiovascular Imaging, 9(3), e003643. https://doi.org/10.1161/CIRCIMAGING.115.003643
Leung M, et al. Impact of Improved Glycemic Control On Cardiac Function in Type 2 Diabetes Mellitus. Circ Cardiovasc Imaging. 2016;9(3):e003643. PubMed PMID: 26962125.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of Improved Glycemic Control on Cardiac Function in Type 2 Diabetes Mellitus. AU - Leung,Melissa, AU - Wong,Vincent W, AU - Hudson,Malcolm, AU - Leung,Dominic Y, PY - 2016/3/11/entrez PY - 2016/3/11/pubmed PY - 2016/7/7/medline KW - diabetes mellitus KW - diabetic cardiomyopathies KW - echocardiography KW - ventricular function, left SP - e003643 EP - e003643 JF - Circulation. Cardiovascular imaging JO - Circ Cardiovasc Imaging VL - 9 IS - 3 N2 - BACKGROUND: Patients with type 2 diabetes mellitus are at risk of heart failure. Specific therapeutic interventions for diabetic heart disease are still elusive. We aimed to examine the impact of improved glycemic control on left ventricular (LV) function in these patients. METHODS AND RESULTS: A total of 105 subjects with type 2 diabetes mellitus (aged 54±10 years) and poor glycemic control received optimization of treatment for blood glucose, blood pressure, and cholesterol to recommended targets for 12 months. LV systolic and diastolic function, measured by LV global longitudinal strain (GLS) and septal e' velocities, were compared before and after optimization. At baseline, patients had impaired LV systolic (GLS -14.9±3.2%) and diastolic function (e' 6.2±1.7 cm/s). After 12 months, glycated hemoglobin (HbA1c) decreased from 10.3±2.4% to 8.3±2.0%, which was associated with significant relative improvement in GLS of 21% and septal e' of 24%. There was a progressively greater improvement in GLS as patients achieved a lower final HbA1c. Patients achieving an HbA1c of <7.0% had the largest improvement. The 15 patients whose HbA1c worsened experienced a decline in GLS. Patients who improved their HbA1c by ≥1.0% had a significantly higher relative improvement in e' than those who did not (32% versus 8%; P=0.003). Baseline GLS, decrease in body mass index, and treatment with metformin were additional independent predictors of GLS improvement. CONCLUSIONS: Improvements in glycemic control over a 12-month period led to improvements in LV systolic and diastolic function. This may have long-term prognostic implications. SN - 1942-0080 UR - https://www.unboundmedicine.com/medline/citation/26962125/Impact_of_Improved_Glycemic_Control_on_Cardiac_Function_in_Type_2_Diabetes_Mellitus_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.115.003643?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -