What is the clinical evidence from this study?

Study design: Editorial. Population: Type 1 diabetes (n=1017). Intervention: Intensive diabetes treatment vs. Conventional diabetes treatment. Primary outcome: Cardiac geometry and function (LV end-diastolic volume, end-systolic volume, stroke volume, cardiac output, LV mass, LV ejection fraction, LV mass/EDV, and aortic distensibility).

September 17, 2013Diabetes43 citationsOpen Access

Diabetes and the Heart: Is There Objective Evidence of a Human Diabetic Cardiomyopathy?

SLSheldon E. LitwinHeart Failure / Cardiomyopathy

Key Result

Intensive diabetes treatment for 6.5 years did not significantly affect long-term cardiac geometry, size, or function compared to conventional treatment in patients with type 1 diabetes followed for 21 years.

Structured PICO

Does intensive diabetes treatment compared to conventional treatment affect long-term cardiac geometry or function in patients with type 1 diabetes?

Population

1,017 patients with type 1 diabetes from the DCCT/EDIC cohort, with a mean age of 49 years and mean diabetes duration of 27 years, followed for approximately 21 years.

Intervention

Intensive diabetes treatment for a mean of 6.5 years

Comparator

Conventional diabetes treatment

Outcome

LV volumes, mass, ejection fraction, and aortic distensibility measured by cardiac MRI at approximately 21 years after initial enrollmentsurrogate

Long-term follow-up of type 1 diabetic patients showed normal cardiac geometry and function regardless of prior intensive versus conventional treatment, raising questions about the existence of a specific diabetic cardiomyopathy.

Limitations

Subtle diastolic and systolic parameters, such as those derived from myocardial strain analysis or tissue Doppler recordings, were not measured.
The study did not include biomarkers relevant to the diagnosis of cardiomyopathy and congestive heart failure, in particular, measurement of natriuretic peptides.
Did not include biomarkers relevant to the diagnosis of cardiomyopathy and CHF, in particular, measurement of natriuretic peptides

Abstract

The concept of a “diabetic cardiomyopathy ” hasbeen invoked to explain the higher than expectedoccurrence of congestive heart failure (CHF)in subjects with diabetes (1,2). However, the evidence supporting the existence of such a condition in humans is mostly inferential. Cardiomyopathies are chronic diseases of the myocardium in which the heart is abnor-mally enlarged, thickened, and/or stiffened. The weakened heart muscle has a reduced ability to pump blood effec-tively. Diabetic cardiomyopathy is frequently considered to be present when there is any abnormality of myocardial diastolic or systolic function, even when very mild, in a di-abetic subject (or animal) without known hypertension or coronary artery disease. Isolated metabolic or biochemical abnormalities in the heart have also been taken as evidence of this entity. It has been referred to as a “specific ” cardio-myopathy that may include features such as left ventricular (LV) hypertrophy, myocardial fibrosis, altered myocardial

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Cite This Study

Sheldon E. Litwin (2013) conducted an editorial in Type 1 diabetes (n=1,017). Intensive diabetes treatment vs. Conventional diabetes treatment was evaluated on Cardiac geometry and function (LV end-diastolic volume, end-systolic volume, stroke volume, cardiac output, LV mass, LV ejection fraction, LV mass/EDV, and aortic distensibility). Intensive diabetes treatment for 6.5 years did not significantly affect long-term cardiac geometry, size, or function compared to conventional treatment in patients with type 1 diabetes followed for 21 years.

synapsesocial.com/papers/6a9625d4defb2fd9efc5d472 https://doi.org/10.2337/db13-0683

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