Effect of tighter glycemic control on cardiac function, exercise capacity, and muscle strength in heart failure patients with type 2 diabetes: a randomized study

Abstract

ObjectivesIn patients with type 2 diabetes (T2D) and heart failure (HF), the optimal glycemic target is uncertain, and evidence-based data are lacking. Therefore, we performed a randomized study on the effect of optimized glycemic control on left ventricular function, exercise capacity, muscle strength, and body composition.Design and methods40 patients with T2D and HF (left ventricular ejection fraction (LVEF) 35±12% and hemoglobin A1c (HbA1c) 8.4±0.7% (68±0.8 mmol/mol)) were randomized to either 4-month optimization (OPT group) or non-optimization (non-OPT group) of glycemic control. Patients underwent dobutamine stress echocardiography, cardiopulmonary exercise test, 6 min hall-walk test (6-MWT), muscle strength examination, and dual X-ray absorptiometry scanning at baseline and at follow-up.Results39 patients completed the study. HbA1c decreased in the OPT versus the non-OPT group (8.4±0.8% (68±9 mmol/mol) to 7.6±0.7% (60±7 mmol/mol) vs 8.3±0.7% (67±10 mmol/mol) to 8.4±1.0% (68±11 mmol/mol); p<0.001). There was no difference between the groups with respect to changes in myocardial contractile reserve (LVEF (p=0.18)), oxygen consumption (p=0.55), exercise capacity (p=0.12), and 6-MWT (p=0.84). Muscle strength decreased in the non-OPT compared with the OPT group (37.2±8.1 to 34.8±8.3 kg vs 34.9±10.2 to 35.4±10.7 kg; p=0.01), in line with a non-significant decrease in lean (p=0.07) and fat (p=0.07) tissue mass in the non-OPT group. Hypoglycemia and fluid retention did not differ between groups.Conclusions4 months of optimization of glycemic control was associated with preserved muscle strength and lean body mass in patients with T2D and HF compared with lenient control, and had no deleterious effect on left ventricular contractile function and seemed to be safe.Trial registration numberNCT01213784; pre-results.

Effectiveness of a multimodal intervention in functionally impaired older people with type 2 diabetes mellitus

“…At 12 months of follow‐up, participants in the IG were significantly more likely to be in the target ranges for both HbA 1c and blood pressure compared with baseline in contrast with participants in the UCG where only blood pressure was significantly more likely to be within target range. It is possible that optimizing glycaemia may have enhanced the effect of exercise and nutrition in improving functional status in the IG because this approach has been shown to preserve muscle strength in patients with dysregulated T2DM (mean age of 67 years) . Alternatively, the effect of resistance training in the IG group may have also contributed to this improved more consistent level of glycaemia via improvements in insulin action in skeletal muscle .…”

“…It is possible that optimizing glycaemia may have enhanced the effect of exercise and nutrition in improving functional status in the IG because this approach has been shown to preserve muscle strength in patients with dysregulated T2DM (mean age of 67 years). 41 Alternatively, the effect of resistance training in the IG group may have also contributed to this improved more consistent level of glycaemia via improvements in insulin action in skeletal muscle. 42 This is an area worthy of further investigation.…”

Latent class analysis suggests four classes of persons with type 2 diabetes mellitus based on complications and comorbidities in Tianjin, China: a cross-sectional analysis

“…Those who were willing to participate in the interview were asked to sign a consent form. The FPG, 2hPG, and HbA1c at diagnosis were extracted from the Tianjin Social Insurance Bureau, and the prevalence of complications and comorbidities diagnosed by secondary or tertiary into several groups based upon different standards, such as physical activity [8], glycemic control [9], age at diagnosis [10], and body mass index (BMI) [11]. However, few studies have attempted to group patients with T2DM by complications and comorbidities.…”

Insulin treatment in heart failure patients: the good, the bad or the ugly?

“…Finally, one minor trial on insulin treatment in chronic heart failure patients randomized 40 HFrEF patients with T2DM to either tight or lenient glucose control with insulin for 4 months. 12 There were no differences between groups with respect to changes in left ventricular contractile reserve by dobutamine echocardiography, diastolic function and the use of diuretics. Altogether, these studies infer no signal of harm of insulin treatment in these T2DM patients with either HFrEF or HFpEF.…”

“…After approximately 2 years of follow‐up, there was no excess mortality or death from heart failure in the group of patients receiving the highest doses of insulin. Finally, one minor trial on insulin treatment in chronic heart failure patients randomized 40 HFrEF patients with T2DM to either tight or lenient glucose control with insulin for 4 months . There were no differences between groups with respect to changes in left ventricular contractile reserve by dobutamine echocardiography, diastolic function and the use of diuretics.…”