Relation of glycosylated hemoglobin and obesity indices with diastolic dysfunction in participants with type 2 diabetes mellitus

Background: Diabetes is an important risk factor of cardiomyopathy which can eventually lead to acute or chronic heart failure. Many factors such as obesity, hyperglycemia, suboptimal glycemic control, and hyperlipidemia predispose as well as aggravate long-term complications in diabetes mellitus (DM). Aim: The present study was conducted to assess the relation of glycosylated hemoglobin (HbA1c) and obesity indices (body mass index [BMI], waist circumference [WC]) with diastolic dysfunction in participants with type 2 DM (T2DM). Methods: This was a cross-sectional study conducted at the teaching hospital during a 1-year period. All 100 consecutive T2DM participants were investigated for HbA1c, blood sugars and lipid profile parameters, and echocardiography. Standardized transthoracic echocardiographic examination was performed (American Society of Echocardiography) using Vivid S6 ultrasound machine with 4–5 MHz probe. Left ventricular diastolic dysfunction (LVDD) was labeled if 3 or more of these variables were abnormal: “Septal e <7 cm/s, lateral e <10 cm/s, E/e' >14, LA volume index >34 mL/m2, and Peak TR velocity >2.8 m/s.” Results: Out of the total 100 diabetics, 37% had diastolic dysfunction (Grade I: 30 [81.08%] and Grade II: 7 [18.91%]). The peak early transmitral filling wave velocity (E) in diabetics with obesity was low as compared to diabetics with normal weight (44 ± 11 cm/s vs. 52 ± 7.5 cm/s). Higher BMI was associated with higher peak late transmitral velocity (A) (61 ± 14 cm/s vs. 38 ± 6.24 cm/s). The mean of E/A ratio was significantly lower in diabetics with obesity. The E/e' ratio was higher in diabetics with obesity (14.8 ± 2.8 vs. 12.86 ± 2.14). The mean of WC was 90.18 ± 6.82 cm in participants of diastolic dysfunction, whereas it was 86.46 ± 6.42 cm in those without dysfunction. Diastolic dysfunction was present in participants with a suboptimal glycemic control, HbA1c ≥ 6.5% (40%), with longer duration of diabetes (62.16%) ( P = 0.003). Thus, a higher BMI was associated with higher diastolic dysfunction ( P = 0.027). Conclusions: The present study reveals burden of LVDD in asymptomatic T2DM participants with its significant association with age, obesity indices (WC and BMI), HbA1c levels, and longer duration of diabetes. This highlights the magnitude of obesity and suboptimal glycemic control that should be considered in the management of cardiac complications in the form of development of diastolic dysfunction. It will benefit in triage for the optimal management of diabetes.

Abstract licence: CC BY-NC-SA

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