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


METHODS
Three 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.


RESULTS
At 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.


CONCLUSIONS
In overweight patients with type 2 diabetes, weight loss and improved glycaemic control had additive beneficial effects on improving LV systolic and diastolic function.
Department of Cardiology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia. melissa@unsw.edu.au.|Ingham Institute for Applied Medical Research, Sydney, NSW, Australia. melissa@unsw.edu.au.|Leiden University Medical Centre, Leiden, The Netherlands. melissa@unsw.edu.au.
Melissa
http://orcid.org/0000-0002-1856-749X
M
Leung
Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.|Liverpool Diabetes Collaborative Research Unit, South Western Sydney Clinical School, University of New South Wales, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.
Vincent W
VW
Wong
The Life Weight Loss Centre, Liverpool, NSW, Australia.
Ertugrul
E
Durmush
Department of Cardiology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.|Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
Victoria
V
Phan
Department of Cardiology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.|Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
Mikey
M
Xie
Department of Cardiology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.|Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
Dominic Y
http://orcid.org/0000-0002-5626-7236
DY
Leung
D000328:Adult; D016279:Atrial Function, Left; D050110:Bariatric Surgery; D001786:Blood Glucose; D001835:Body Weight; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D058065:Diabetic Cardiomyopathies / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006331:Heart Diseases / Q000209:etiology*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left; D015431:Weight Loss
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents
Bariatric surgery; Diabetic cardiomyopathy; Echocardiography; Glycaemic control; Left ventricular function; Strain; Weight loss
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