Increased body mass index (BMI) found to be associated with cardiac impairement in patients with type 1 diabetes mellitus

Correlation analysis of clinical and laboratory parameters with cardiac chamber size
Correlation analysis of clinical and laboratory parameters with cardiac chamber size

Diabetes mellitus induces cardiac dysfunction unrelated to arterial hypertension and other frequent comorbidities. While most previous studies included patients with type 2 diabetes mellitus, more recent studies have confirmed a higher prevalence of cardiac impairment in patients with type 1 diabetes mellitus as well.

The aim of our study was to find potential early cardiac changes predictors in these patients, which have not been elucidated yet. Sixty-one middle-aged asymptomatic patients with type 1 diabetes mellitus were included in the study. We performed a detailed clinical examination, a transthoracic echocardiography and laboratory tests in all patients. Notably, we discovered a consistent association with cardiac chambers size and performance only for the body mass index (BMI). However, no association of diabetes duration, the long-term trend of glycemic control, renal function and lipids with cardiac structure and function were found.

Finally, the results of our study show that increased BMI potentiates the negative effects of diabetes mellitus on the heart and we recommend early screening of these patients with echocardiography. As our study was cross-sectional and hypothesis-generating, further studies are warranted to confirm the causal relationship of obesity with early cardiac changes in patients with type 1 diabetes mellitus.

Slovenian language summary

Sladkorna bolezen povzroča spremembe na srčni mišici neodvisno od povišanega krvnega tlaka in pogostih drugih pridruženih bolezni. Večina predhodnih raziskav je vključila bolnike s sladkorno boleznijo tipa 2, novejše raziskave pa so potrdile pogostejšo okvaro srčne mišice tudi pri bolnikih s sladkorno boleznijo tipa 1.

Cilj naše raziskave je bil opredeliti do sedaj še neznane napovedne dejavnike zgodnje okvare srca pri sladkornih bolnikih tipa 1. V raziskavo smo vključili 61 asimptomatskih bolnikov s sladkorno boleznijo tipa 1 srednjih let. Vsem bolnikom smo opravili natančen klinični pregled, transtorakalno ultrazvočno preiskavo srca in laboratorijske preiskave. Ugotovili smo, da je bil samo indeks telesne mase  pomembno povezan  z velikostjo srčnih votlin in delovanjem srca.  Nismo ugotovili povezave med strukturo in delovanjem srca ter trajanjem sladkorne bolezni, dolgoročnim trendom urejenosti glikemije, ledvičnim delovanjem in krvnimi maščobami.

Na podlagi naših rezultatov sklepamo, da povečan indeks telesne mase okrepi negativne učinke sladkorne bolezni na srčno mišico in pri teh bolnikih svetujemo zgodnjo ultrazvočno diagnostiko. Ker je bila naša raziskava presečna, je potrebno hipotezo o vzročni povezavi med debelostjo in zgodnjimi srčnimi spremembami pri bolnikih s sladkorno boleznijo tipa 1 potrditi z nadaljnjimi raziskavami.

Reference

David Šuran, Vojko Kanič, Franjo Naji, Igor Krajnc, Miro Čokolič, Eva Zemljič, Andreja Sinkovič. Predictors of early cardiac changes in patients with type 1 diabetes mellitus: an echocardiography-based study.  2019 Jun 18. doi: 10.17305/bjbms.2019.4250. [Epub ahead of print]

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