Patients with diabetes mellitus exhibit impaired systolic and diastolic function even in the absence of coronary artery disease (CAD), Danish researchers have shown.

Noting that myocardial dysfunction is a marker of adverse prognosis, they recommend that diabetes patients should be regarded as a high-risk group, even when standard coronary angiography and echocardiography results are normal.

Charlotte Andersson (University of Copenhagen) and co-workers assessed cardiac function in 31 patients with diabetes and 31 healthy controls matched for age, gender, and presence of hypertension. All participants had a left ventricular ejection fraction (LVEF) above 35% and none had significant CAD or other heart disease.

“Patients with diabetes mellitus have high risk of heart failure,” they explain. “Whether some of the risk is directly linked to metabolic derangements in the myocardium or whether the risk is primarily caused by CAD and hypertension is incompletely understood.”

The participants underwent echocardiographic tissue Doppler imaging to assess myocardial function.

Writing in the journal Cardiovascular Diabetology, Andersson et al reveal that mean LVEF, mean left atrial end-systolic volume, mean LV dimensions, and prevalence of diastolic dysfunction were comparable between participants with and without diabetes.

However, diabetes patients had significantly reduced measures of global longitudinal strain (15.9% vs 17.7%), peak longitudinal systolic velocity (5.7 vs 6.4 cm/s) and early diastolic velocity (6.1 vs 7.7 cm/s) compared with controls.

Furthermore, in multivariable regression analyses, diabetes remained associated with impairments in both peak systolic and early diastolic tissue velocities, with mean values in diabetes patients being 89% and 79%, respectively, of those in controls. The presence of hypertension did not modify these findings.

The researchers remark that the Doppler-detected abnormalities observed in diabetes patients were not identifiable from any of the conventional echocardiographic parameters; the findings are therefore “directly applicable to everyday clinical practice.”

“In a clinical context, the subclinical impairments of left ventricular function in patients with diabetes mellitus recognized to carry an adverse prognosis,” they write.

“The results from the present study further emphasize that patients with diabetes mellitus should continuously be regarded as a high-risk group, even when cardiac angiography and conventional echocardiography investigations appear normal.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

Free abstract

Results from a prospective cohort study carried out at a hospital in the Bronx area of New York in the USA suggest that many patients without diagnosed diabetes have abnormally high glycated hemoglobin (HbA1c) levels and are at increased risk for Type 2 diabetes.

“Hospital-based HbA1c testing might identify patients for whom further testing is indicated to make the diagnosis of diabetes,” suggest the researchers.

Charles Nordin (Jacobi Medical Center, Bronx, New York, USA) and colleagues tested HbA1c levels of 971 patients admitted to the general medicine service of a Bronx hospital over a 4-month period.

The team checked records for prior diagnosis of diabetes and other relevant data and followed-up patients who had repeat testing of HbA1c or glucose within 1 year of admission.

The Bronx area has a diabetes prevalence that is one of the highest in the USA and in line with this 342 (35.2%) patients tested had diabetes.

A normal HbA1c is generally considered to be below 6%. The mean HbA1c of the remaining cohort (n=629) was 6.05%. Of these patients, 152 (24%) had an admission HbA1c of at least 6.5% and 62 (9.9%) had an HbA1c of at least 7.0%.

In total, 55 of the patients with an admission HbA1c of at least 6.5% had a follow-up HbA1c test within 1 year, at which point 44 (88%) patients met the criteria for diabetes proposed by The International Expert Committee using repeated HbA1c testing.

“Our study supports the hypothesis that HbA1c testing on the inpatient service of a public hospital in a high-risk community can help to identify patients at risk for diabetes,” conclude the authors in the Journal of Clinical Endocrinology and Metabolism.

The researchers caution that use of single HbA1c measurements for diagnosing diabetes is unwise as factors such as hospital admission can significantly influence HbA1c levels.

They add: “Further studies will be needed to determine the role of inpatient HbA1c testing for diagnosis and treatment of diabetes.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

Free abstract

Diabetes is a very common disease among almost, if not, all countries across the globe. Morbidity and mortality rates are enough evidences of how this disease has affected quite a lot of people even in cases when it is not the main source of death, there were complications with diabetes found among most patients. With such debilitating and serious effects, it is important to be able to make use of diabetes management effectively.

Defined as a medical condition revolving around the body’s reaction to insulin, diabetes actually is of two types. Basically, the pancreas produces insulin, which is the reason why cells can absorb glucose for the purpose of turning it into energy. In the absence of insulin or when there is insufficient amount of it, glucose tends to get accumulated in the blood. This can result to different complications.

People with diabetes tend to experience frequent hunger and feeling of being thirsty. They also urinate more frequently than the usual. Weight loss, eyesight problems and feelings of fatigue and irritation can also be observed. Another very popular signs of diabetes is the slow healing of cuts, bruises and other wounds. Skin, gum, bladder and other infections tend to reoccur.

These symptoms might not occur all at the same time. In fact, there are cases where only one of these is observed. One should be constantly on the lookout for irregularities in the bodily functions in order to avoid going past certain symptoms that might be related with serious diseases such as diabetes.

It is a trusted fact that prevention has always been better than cure no matter what diseases they come in. Statistics show that the onset of type 2 diabetes is during adulthood, but in the recent years, obesity rates grew tremendously, and diabetes grew hand in hand with it. The most effective way to avoid having diabetes is to maintain a healthy obesity-free lifestyle.

For those with diabetes, there is a great need for a complete lifestyle makeover. One of the basic things to do is to incorporate regular exercise into one’s daily activities. The goal with this is to burn as much glucose as possible since insulin, the main one responsible for such, cannot fully live up to its purpose. More so, one should be wary of his own body weight. Obesity is highly associated with the development of diabetes.

Another change that should be taken is regarding one’s diet. Although the no-sugar diet is a myth, it is still very important for a person with diabetes to refrain from consuming much sugar. The idea is to have a healthy and balanced diet. The body still needs sugar, but it takes much insulin to break it down into energy. For a healthier diet, one can incorporate high fiber foods items as well as soya products. As a matter of fact, scientific studies can back up the good effects of such a diet on diabetes patients.

The management of diabetes takes as much effort as other serious diseases. However, all of these are worth it considering the positive results in the end.