A randomized trial of the impact of strict glycaemic control on myocardial diastolic function and perfusion reserve: a report from the DADD (Diabetes mellitus And Diastolic Dysfunction) study

Abstract

AimsMyocardial diastolic dysfunction (MDD) and impaired coronary flow reserve (CFR) are early signs of myocardial involvement in patients with diabetes. The important question of whether this may be reversed by glucose normalization has not been tested in a controlled clinical trial. We hypothesized that strict glycaemic control, particularly if insulin based, will improve MDD and CFR. Methods and resultsThirty-nine type 2 diabetes patients (mean age 61.0 + 7 years) with signs of diastolic dysfunction were randomly assigned to strict metabolic control by insulin (I-group; n ¼ 21) or oral glucose lowering agents (O-group; n ¼ 18). MDD and CFR were studied with Doppler-echocardiography including Tissue Doppler Imaging and myocardial contrast enhanced echocardiography. Fasting glucose (I-group ¼ 22.2 + 2.1; O-group 21.5 + 0.8 mmol/L) and HbA 1c were normalized (20.6 + 0.4 and 20.7 + 0.4%, respectively) in both groups, but this did not significantly improve MDD in either of the groups (P ¼ 0.65). There was no difference in CFR before and after improved glycaemic control. ConclusionThe hypothesis that strict glycaemic control would reverse early signs of MDD and improve CFR in patients with type 2 diabetes could not be confirmed, despite achieved normalization. Whether it is possible to influence a more pronounced diastolic dysfunction, particularly in less well-controlled diabetic patients, remains to be established.--

Impact of Improved Glycemic Control on Cardiac Function in Type 2 Diabetes Mellitus

“…The study by von Bibra et al 26 showed that intensive metabolic control with insulin therapy resulted in improvements in diastolic but not in systolic function, whereas studies by others failed to demonstrate improvements in either diastolic or systolic function, using tissue Doppler and ejection fraction measures, despite better glycemic control. [27][28][29] Most of these studies examined intensified glycemic control over shorter periods of time than our study, and it is possible that these short periods of improved glycemic control were insufficient for detectable changes in cardiac function to occur.…”

Diabetes Mellitus Worsens Diastolic Left Ventricular Dysfunction in Aortic Stenosis Through Altered Myocardial Structure and Cardiomyocyte Stiffness

“…3 Their relative contributions to myocardial stiffness differ in HFREF and HFNEF; fibrosis and AGEs are more important in HFREF and high F passive is more prominent in HFNEF. 3 Like macrovascular complications, 11,12 DM-related diastolic LV dysfunction failed to improve during intensified glycemic control, 13 and because of this "hyperglyce-mic memory," involvement of epigenetic processes was recently suspected. 14,15 …”

Selective endothelin A-receptor blockade attenuates coronary microvascular dysfunction after coronary stenting in patients with type 2 diabetes

“…42 Blood pressure prior to PCI was well controlled in all patients prior to PCI, however, intraarterial measured systolic and diastolic blood pressures at baseline was higher in nondiabetic controls and patients in BQ123 group, and remained higher in these two groups at the end of PCI procedure. Despite higher blood pressure, CFR was higher in patients receiving BQ123, indicating a positive effect of selective ET A blockade on myocardial microcirculation.…”