ABSTRACT
The study based on assessment of changes in left ventricular dimensions and mass in Type-II diabetic patients and to correlate the effect of plasma insulin and serum glucose levels on changes might affect the Lv in absence of increased systemic blood-pressure Hyperglycemia, insulin resistance, cytokines, and vasoactive hormones are the most important factors that lead to advance and progression of abnormal cell growth. Like hypertension, diabetes can cause fibrosis of the myocardium and increased collagen deposition in absence of systemic hypertension or other causes of Lv hypertrophy. The study includes 44 patients previously diagnosed as normotensives type-Il diabetis and after applying exclusion criteria, they are divided into Four-groups based on the treatment protocol [orall or insulin] and the state of glycemic control [controlled or uncontrolled]. Group-I [controlled diabetics on oral theray], included 10 patients with their age of mean +/- SD [44.0 +/- 5.2], Group-Il, [uncontrolled orally treated diabetics], included 12 patients with age of mean +/- SD [46 +/- 4.2], Group-Ill [controlled diabetic on insulin therapy], included 9 patients with their age of mean +/- SD [45 +/- 4.1], and Group-IV [uncontrolled insulin treated diabetics], included 13 patients with age of mean +/- SD [45 +/- 3.8]. All patients in all groups were subjected to [full clinical evaluation and routine examination, laboratory assessment of basal glucose and insulin serum levels after 8-hours of no calorie intake, estimation of insulin-resistance indices by Glucose/Insulin ratio and HOMA test was meticulously analyzed, then M-mode Echocardiographic assessment of Lv-diastolic dimensions to estimate Lv-mass and mass index in relation to their body surface area]. After collection of both laboratory and Echocardiographic data, analyses of the results revealed that, in demographic features there's no significant variation of age in between all groups, however, body weight was significantly increased in group III than other groups with [p=0.001], and no significant variation of body height and BSA among all groups. Comparing the laboratory data between group I to group III- [controlled diabetics] revealed that, there's a significant variation in all laboratory data between both groups in the form of; higher FBG, basal insulin, HBA1C, and HOMA with significant lower G/I in group III versus group I with p=0.001 for all apart from p=0.05 for HBA1C only. Moreover, comparing laboratory data between uncontrolled-diabetic groups [group II and IV] revealed that, there's a significant variation in all laboratory data between both groups in the form of; higher FBG, basal insulin, HBA1C, and HOMA with significant lower G/l in group IV versus group II with p=0.001 for all results. Comparing Echocardiographic data revealed that, there's no significant variation in all Echocardiographic data between controlled diabetic groups [group I and III] with septal thickness, [0.9 +/- 0.22 in group I vs 0.93 +/- 0.11 in group III], LVEDD [45.4 +/- 6.6 in group I vs 48.5 +/- 1.5 in group III], posterior wall thickness [0.97 +/- 0.21 in group I vs 0.86 +/- 0.01 in group III], Lv mass [168.8 +/- 21.17 in group I vs 179.1 +/- 32.4 in group III] and Lv mass Index [91.2 +/- 10.8 in group I vs 85.4 +/- 17.5 in group III]. However, comparison between uncontrolled groups [group II and IV] revealed that, in spite of there's no significant variation in relation to LVEDD and PWT. there's a significant [p=0.03] increased septal thickness in group IV than group II [0.9 +/- 0.17 in group II vs 1.15 +/- 0.11 in group IV] and a significant [p=0.03] increased Lv mass and mass index in group IV [lv mass 196.5 +/- 25.4 in group II vs 232.4 +/- 27.8 in group IV Lv mass index was 101.3 +/- 15.0 in group II vs 120.4 +/- 13.5 in group IV]. Correlation of laboratory data to Echocardiographic findings between controlled and un-controlled groups revealed that, there's a positive correlation of increased Lv-mass and mass index with higher basal glucose [P 0.018 and r 0.355] and insulin levels [P 0.001 and r 0.48]. Also, positive correlation with elevated HBA1C [P 0.001 and r 0.71], elevated HOMA level [P 0.001 and r 0.477]. However, negative correlation with G/I Ratio [P 0.02 and r - 0.34]. Laboratory data revealed a significant variation in all parameters between controlled and uncontrolled diabetics in relation to basal levels of glucose and insulin and more evidenced insulin resistance in uncontrolled groups, which means that, in uncontrolled glycemic state there's more increase in glucose and insulin levels with resultant more insulin resistance whatever the mode of treatment [oral or insulin]. Echocardiographic data revealed that, no differences in between controlled diabetics but, a significant increased septal wall thickness is observed in uncontrolled groups with resultant increased in their Lv mass and mass index and this conclude that, in uncontrolled glycemic state, their a tendency to increased Lv mass in spite of the mode of treatment [either oral or insulin]. Elevated fasting blood glucose, basal insulin, HBA1C, HOMA and reduced glucose/insulin ratio are highly correlated to increased Lv mass and mass index and this is not related to either controlling blood glucose or the mode of treatment oral or insulin