title: 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: OBJECTIVE
  In 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.
  
  
  METHODS
  40 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.
  
  
  RESULTS
  39 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.
  
  
  CONCLUSIONS
  4 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.
  
  
  BACKGROUND
  NCT01213784; pre-results.
authors.affiliation: Department of Medicine, Viborg Hospital, Viborg, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Roni
authors.initials: R
authors.lastname: Nielsen
authors.affiliation: Department of Medicine , Viborg Hospital , Viborg , Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Wiggers
authors.affiliation: Department of Endocrinology and Metabolism , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Henrik Holm
authors.initials: HH
authors.lastname: Thomsen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Medicine, Herning Hospital, Herning, Denmark.
authors.forename: Ann
authors.initials: A
authors.lastname: Bovin
authors.affiliation: Department of Cardiology , Viborg Hospital , Viborg , Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Refsgaard
authors.affiliation: Department of Clinical Physiology , Viborg Hospital , Viborg , Denmark.
authors.forename: Jan
authors.initials: J
authors.lastname: Abrahamsen
authors.affiliation: Department of Endocrinology and Metabolism , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Møller
authors.affiliation: Department of Cardiology , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Bøtker
authors.affiliation: Aarhus University Hospital Clinical Trial Unit , Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Helene
authors.initials: H
authors.lastname: Nørrelund
keywords: Glycemic Control; Heart Failure; Stress Echocardiography; Type 2 Diabetes