Title: Glycosylated Hemoglobin and Left Ventricular Diastolic Dysfunction in Type 2 Diabetes Mellitus Patients
Authors: Dr Raghib Hasan, Dr M. Ghosh, Dr P. K. Agrawal, Dr Taskeen Ahmad, Dr Ashique Saikh, Dr Farogh Haidry, Dr Tabrez Alam
DOI: https://dx.doi.org/10.18535/jmscr/v6i11.05
Abstract
INTRODUCTION: Diabetes Mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia.The diastolic abnormalities are present in diabetic patients without overt diabetic complications of cardiovascular system, it is the earliest and specific functional abnormality in diabetic cardiomyopathy and can affect patients who are free of macrovascular complications, even in newly diagnosed diabetes mellitus patients or in those with a disease duration of less than 1 year.Diastolic dysfunction (DD) has been broadly defined as left ventricular diastolic dysfunction (LVDD) indicating a functional abnormality of diastolic relaxation, elasticity or distensibility of the left ventricle (LV), regardless of whether the left ventricle ejection fraction (LVEF) is normal or abnormal and whether the patient is symptomatic or not.
AIMS AND OBJECTIVES: (a) To assess the prevalence of diastolic dysfunction in patients with type 2 diabetes. (b) To assess the correlation of diastolic dysfunction and HbA1c levels.
METHOD:100 patients of Type-2 DM attending the medicine outpatient/inpatient department of Katihar Medical College and Hospital were shortlisted for Doppler echocardiography and HbA1c levels.
Inclusion criteria:Age group 30-55yrs independent of sex, clinically proven case of type-2 diabetes mellitus.
Exclusion criteria:patients with systemic hypertension, thyroid disease, stroke, peripheral vascular disease,family history of heart disease,pregnancyand patients not willing to give consent for the study.
RESULTS:In the present study among 100 diabetic patients 57 were positive and 43 were negative for diastolic dysfunction.E/A was 1.02 and 1.23 in diastolic dysfunction positive and negative patients respectively. There was significant reduction in E/A ratio in patients with diastolic dysfunction, (p<0.001). 6 patients belong to group with HbA1c% <5.6 out of which 4 were positive and 2 were negative for diastolic dysfunction, 28 patients belong to HbA1c% range of 5.7 – 6.4 out of which 4 were positive and 24 were negative and 66 patients belong to HbA1c% range of >6.4 out of which 49 were positive and 17 were negative for diastolic dysfunction. Ejection fraction percentages were 63.40 in diastolic dysfunction positive and 68.90 in negative patients.
CONCLUSION: HbA1c% measurement can be a very good indicator of long-term prognosis in diabetics. Evenyoung diabetics with normal systolic ventricular function have diastolic dysfunction, which serves as a indicator of a diabetic cardiomyopathy. The results from this study reinforce the important role of Doppler echocardiography to evaluate the heart diastolic function parameters in diabetics. Early diagnosis and therapeutic interventions in diabetes mellitus with regular follow-up before the deleterious cardiac sequelae become established clinically, modulate the cardiac metabolism and prevent heart failure.
