Cardiac dysfunction in type II diabetes: a bittersweet, weighty problem, or both?

Abstract

Aims Weight loss in obese patients leads to improved left ventricular (LV) function. It is unclear whether improving glycaemic control has additional benefits to weight loss alone in patients with type 2 diabetes, or if benefits of weight loss are mediated through improving glycaemic control. This case–control study examined the incremental impact of these approaches on LV function. MethodsThree groups of age, gender, and baseline HbA1c-matched patients with type 2 diabetes and suboptimal glycaemic control were followed-up for 12 months. Group 1 patients did not improve HbA1c ≥ 1 % (10.9 mmol/mol) or lose weight. Group 2 improved HbA1c ≥ 1 % but did not lose weight. Group 3 improved HbA1c ≥ 1 % (10.9 mmol/mol) and lost weight. All patients underwent transthoracic echocardiogram at baseline and at follow-up.ResultsAt baseline, three groups were comparable in all clinical and metabolic parameters except Group 3 had highest body mass index. The three groups had similar echocardiographic parameters except Group 3 had the worst LV systolic function [global longitudinal strain (GLS)]. At follow-up, LV ejection fraction and diastolic function improved with a reduction in filling pressures in Group 2 and more so in Group 3. LV filling pressures in Group 1 increased. There was a significant improvement in GLS in Group 2 and more so in Group 3. Despite GLS being the worst in Group 3 at baseline, this was comparable between Groups 2 and 3 at follow-up.ConclusionsIn overweight patients with type 2 diabetes, weight loss and improved glycaemic control had additive beneficial effects on improving LV systolic and diastolic function.

Bariatric Surgery and Myocardial Mechanics: A Meta-Analysis of Speckle Tracking Echocardiographic Studies

“…Therefore, 102 studies were reviewed; of these, 77 did not report data on myocardial mechanics, and 24 were reviews, commentary, editorial articles, case reports and studies including less than 10 participants. Thus, a total of 13 studies including patients treated with bariatric surgery for a period longer than one month and containing echocardiographic data of interest were included in the final review [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ] ( Figure 1 ). According to the NOS, the quality of the studies ranged from 6 to 9 (i.e., a score that identifies studies of fair or good quality) [ 29 ].…”

Assessment of subclinical diabetic cardiomyopathy by speckle‐tracking imaging

“…Several studies outline the importance of weight loss in the reversibility of systolic and diastolic dysfunctions in DM patients 42,65,66 . M. Leung et al found that weight loss in type 2 DM was as important as glycaemic control for the improvement of systolic and diastolic function, the improvement being even greater when both glycaemic control and weight loss were obtained 65 .…”

“…Furthermore, Lorenzo‐Almoros et al showed that intensive glycaemic control in humans (HbA1c < 7%) does not prevent cardiovascular complications in patients suffering from DM, 1 and several other studies found no association between HbA1c levels and systolic dysfunction 8,64 . However, many recent studies found that the biggest improvements in diastolic and systolic functions were seen in patients with the largest reduction in HbA1c levels 2,5,18,25,33,43,65 …”

“…Several studies outline the importance of weight loss in the reversibility of systolic and diastolic dysfunctions in DM patients 42,65,66 . M. Leung et al found that weight loss in type 2 DM was as important as glycaemic control for the improvement of systolic and diastolic function, the improvement being even greater when both glycaemic control and weight loss were obtained 65 . The same team demonstrated in another study that patients who develop worsened glycaemic control, even after a long period of proper glycaemic control, experience further deterioration of LV systolic function 18 .…”

Left ventricular diastolic dysfunction in diabetes mellitus and the therapeutic role of exercise training

“…Nevertheless, in patients without concomitant disease such as HT and CAD, followed up for 6 years, the authors reported that the prevalence of LVDD was relatively low, suggesting that in the early stage of LVDD, there may be a slow progression of myocardial changes (26). Duration of diabetes, age and abnormally elevated levels of Hb1AC were independently correlated with LVDD in several studies (15,21,27,28,29). An independent relationship between LVDD and BMI was also reported (18,22,28).…”