Diastolic Function and Type 1 Diabetes

Diabetes is a risk factor for the development of symptomatic heart failure, particularly in elderly patients with type 2 diabetes (1,2). Heart failure that occurs as the result of impaired myocardial relaxation and compliance has been termed diastolic heart failure (3). Diastolic heart failure develops despite normal left ventricular systolic contractile function and leads to significant morbidity, medical costs, and mortality. Typically, patients with type 2 diabetes who are symptomatic from diastolic heart failure have superimposed hypertension, coronary artery disease, left ventricular hypertrophy, atrial fibrillation, or renal insufficiency (4). Alterations in diastolic function are also frequently observed in asymptomatic individuals with type 1 diabetes (5,6), although their contribution to the development of clinical heart failure later in life remains uncertain. In this issue of Diabetes Care , Suys et al. (7) provide new evidence that children and adolescents with type 1 diabetes have altered cardiac structure and function compared with age-matched individuals without diabetes. Subjects included in the study had no cardiac signs or symptoms or diabetes complications and were not taking medications known to modify cardiac structure or function (presumably including ACE inhibitors). The most striking findings were in the girls with type 1 diabetes, who had greater left ventricular size and reduced diastolic function compared with control subjects. The fact that they were otherwise healthy young individuals without hypertension makes these observations all the more noteworthy. The findings in boys with type 1 diabetes were somewhat less dramatic and consistent. A number of conventional echocardiographic parameters were evaluated. Left ventricular wall thickness was 10% greater, and there was a trend toward increased left ventricular mass and left ventricular mass index (corrected for BMI) in the girls (but not boys) with type 1 diabetes. The study did not address the …