Sliem Hamdy, Nasr Gamela
Department of Internal Medicine, Suez Canal University, Egypt.
J Cardiovasc Dis Res. 2011 Jan;2(1):23-8. doi: 10.4103/0975-3583.78583.
Several studies have shown that ventricular dysfunction is increased in individuals with diabetes. Insulin resistance (IR) may precede type 2 diabetes, and is a pathogenic factor for it. Furthermore, IR has been shown to be an independent predictor of cardiovascular disease in diabetes. Given that glucose intolerance and IR precede the development of overt diabetes, these factors would be associated with abnormal myocardial performance.
To evaluate the state of left ventricular structure and function in prediabetic adults in relation with IR.
A case-control study was performed. One hundred and twenty-one consecutive adults with prediabetes were enrolled for the study. Forty-two of the adults had IR (group A) and 79 had insulin sensitivity (group B). Forty-three healthy (with normal blood glucose) adults matched for age and gender were considered as a control group. All groups were subjected to full medical history and clinical examination and biochemical and echocardiographic studies.
There were no statistically significant differences between the insulin-sensitive prediabetic group and the control group in all parameters of left ventricular structure and systolic and diastolic functions. Significant differences were observed between group A and control group in the parameters of left ventricular diastolic function (both isovolumetric relaxation time and E/A ratio). Regarding correlation between the parameters of diastolic function and different variables of IR prediabetic group, there was a statistically significant coefficient correlation with HOMA IR, waist circumference and triglycerides. No correlation was observed with fasting glucose, Hb A1c, body mass index, blood pressure (BP) and total lipids.
In prediabetic adults, IR is associated with impaired left ventricular diastolic function, and this association appears to be independent of BP, ventricular geometry, glucose tolerance status, total plasma lipids and obesity.
多项研究表明，糖尿病患者的心室功能障碍有所增加。胰岛素抵抗（IR）可能先于2型糖尿病出现，并且是其致病因素。此外，IR已被证明是糖尿病患者心血管疾病的独立预测因子。鉴于葡萄糖耐量异常和IR先于显性糖尿病的发生，这些因素可能与心肌功能异常有关。
评估糖尿病前期成年人左心室结构和功能状态与IR的关系。
进行了一项病例对照研究。连续纳入121名糖尿病前期成年人进行研究。其中42名成年人存在IR（A组），79名具有胰岛素敏感性（B组）。将43名年龄和性别匹配的健康（血糖正常）成年人作为对照组。所有组均接受完整的病史、临床检查以及生化和超声心动图检查。
胰岛素敏感的糖尿病前期组与对照组在左心室结构以及收缩和舒张功能的所有参数方面均无统计学显著差异。A组与对照组在左心室舒张功能参数（等容舒张时间和E/A比值）方面存在显著差异。关于糖尿病前期组舒张功能参数与IR不同变量之间的相关性，与HOMA-IR、腰围和甘油三酯存在统计学显著的系数相关性。与空腹血糖、糖化血红蛋白、体重指数、血压（BP）和总脂质未观察到相关性。
在糖尿病前期成年人中，IR与左心室舒张功能受损有关，并且这种关联似乎独立于BP、心室几何形态、葡萄糖耐量状态、总血浆脂质和肥胖。
