ABSTRACT
AIMS: 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.
Subject(s)
Body Weight , Diabetes Mellitus, Type 2/complications , Diabetic Cardiomyopathies/physiopathology , Heart Diseases/etiology , Adult , Atrial Function, Left , Bariatric Surgery , Blood Glucose , Case-Control Studies , Diabetes Mellitus, Type 2/diagnostic imaging , Diabetes Mellitus, Type 2/drug therapy , Diabetic Cardiomyopathies/diagnostic imaging , Echocardiography , Echocardiography, Doppler , Female , Follow-Up Studies , Glycated Hemoglobin/analysis , Humans , Hypoglycemic Agents/therapeutic use , Male , Middle Aged , Observer Variation , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/physiopathology , Ventricular Function, Left , Weight LossABSTRACT
BACKGROUND: Diabetic cardiomyopathy is an increasingly prevalent health issue, with no specific management options. We examined the impact of weight loss with sleeve gastrectomy on diabetic cardiomyopathy. METHODS: Eight obese patients with type 2 diabetes undergoing sleeve gastrectomy had left ventricular (LV) systolic and diastolic function assessed by global longitudinal strain (GLS) and septal early diastolic velocity (e') using echocardiography, before and 9 months after surgery. RESULTS: Following surgery, mean weight loss was 28.0 ± 16 kg; body mass index (BMI) decreased from 44 ± 9 to 35 ± 6 kg/m(2) (p < 0.001). Glycaemic control improved with glycated haemoglobin (HbA1c) improving from 9.2% at baseline to 6.7% at follow-up (p = 0.002), with a corresponding improvement in LV GLS from -13.2 ± 3.7 to -19.7 ± 2.2% (p < 0.001), and LV ejection fraction from 60 ± 5 to 70 ± 4% (p < 0.001). Improvement in GLS was associated with the amount of weight lost (ρ = 0.81, p = 0.015). LV septal e' velocities increased, and LV filling pressures decreased after surgery. CONCLUSIONS: Weight loss with sleeve gastrectomy in obese patients with type 2 diabetes is effective in improving glycaemic control in subjects with type 2 diabetes and results in significant improvement in both systolic and diastolic myocardial function.
