Impact of glycemic optimization on myocardial steatosis and cardiac remodeling in patients with newly diagnosed type 2 diabetes: a longitudinal study

20 adults (age ≥ 18 years) with newly diagnosed type 2 diabetes, median age 55.5, 80% male, from a single center in Spain. Exclusions: GAD65 positive, receiving steroids or immunosuppressive therapy, eGFR < 60 mL/min/1.73 m2, elevated liver enzymes ≥ 3 times upper limit of normal, liver cirrhosis, pancreatic disease, known coronary artery disease, heart failure, or active malignancy.

12-month standardized glycemic optimization protocol including nutritional and lifestyle counseling. Initial pharmacological therapy: insulin glargine U-100 (0.2 IU/kg/day), sitagliptin (100 mg/day), and metformin (1,700 mg/day). After two weeks, basal insulin was suspended and sitagliptin was replaced with empagliflozin (10 mg/day).

Within-subject changes in myocardial triglyceride content (MTGC) assessed by ¹H-MRS between baseline and 12 months of follow-up.surrogate