Improved glycemic control induces regression of left ventricular mass in patients with type 1 diabetes mellitus.
BACKGROUND
Diabetes mellitus has been associated with abnormalities of cardiac function and left ventricular hypertrophy. We sought to determine whether improved glycemic control in patients with type 1 diabetes mellitus will induce reversal of those abnormalities.


METHODS
We prospectively studied 19 patients (mean age 40+/-9 years) with longstanding type 1 diabetes mellitus (28+/-4 years), who participated in a program of stringent glycemic control. Glycemic control was monitored with hemoglobin A1c levels, and improvement was defined as >1% (absolute) decrease of hemoglobin A1c. Two-dimensional and Doppler echocardiograms and ambulatory 24-h blood pressures were obtained at baseline and after 1 year. Left ventricular mass was determined using the area-length method.


RESULTS
In the patients with improved glycemic control (n=12), hemoglobin A1c decreased from 9.8% to 7.8% (p< or =0.0001), interventricular septal thickness decreased from 10.3 to 9.4 mm (p< or =0.05), and left ventricular mass regressed from 205 to 182 g (p< or =0.05). Septal thickness and left ventricular mass remained unchanged in the patients who did not achieve improvement of glycemic control. Left ventricular internal diameters, posterior wall thickness, fractional shortening, E/A ratio of mitral inflow, E-wave deceleration time (DT), and ambulatory 24-h blood pressures did not change significantly after 1 year in either group.


CONCLUSIONS
Improved glycemic control in patients with type 1 diabetes mellitus is associated with regression of septal thickness and left ventricular mass without significant effect on systolic or diastolic function, in the absence of significant alterations in ambulatory 24-h blood pressures.
Aepfelbacher
Franz C
FC
Noninvasive Cardiology Laboratory, Cardiovascular Division, Beth Israel Deaconess Medical Center, Baker-3, 1 Deaconess Road, Boston, MA 02215, USA.
Yeon
Susan B
SB
Weinrauch
Larry A
LA
D'Elia
John
J
Burger
Andrew J
AJ
D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D018660:Blood Pressure Monitoring, Ambulatory; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D015150:Echocardiography, Doppler; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006346:Heart Septum / Q000473:pathology; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000473:pathology / Q000517:prevention & control*; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D011446:Prospective Studies; D013997:Time Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin