Guria Rishi T, Prasad Manoj K, Mishra Brajesh, Marandi Sujeet, Kumar Amit, Dungdung Ajit
Internal Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND.
Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND.
Cureus. 2022 Nov 17;14(11):e31626. doi: 10.7759/cureus.31626. eCollection 2022 Nov.
Background Some literature has shown a high prevalence of pre-clinical diastolic dysfunction in subjects with type 2 diabetes mellitus. The current study was carried out to determine the association of glycosylated hemoglobin (HbA1c) levels with left ventricular diastolic dysfunction (LVDD) in patients with type 2 diabetes. Methods An observational cross-sectional study was conducted in a tertiary health care center in Jharkhand. A total of 100 subjects diagnosed with type 2 diabetes mellitus who gave informed consent and fulfilled the inclusion and exclusion criteria were studied in our center from April 2019 to September 2020. Logistic regression was carried out to determine the association of potential variables with outcomes. Multivariable logistic regression analysis was conducted to determine the independent effects of variables for LVDD prediction. Results The mean HbA1c of the population with LVDD was found to be higher (11.07 ± 3.66%) as compared to the population with normal LVDD (9.11 ± 2.95%), which was found statistically significant (probability value (P) =0.004). This signifies that a higher level of HbA1c in a patient with diabetes will have a higher incidence of LVDD. On applying multivariate analysis to determine the independent effect of variables for LVDD, HbA1C was found to be significant with an odds ratio (OR) of 1.26, 95% CI 1.08-1.48. The duration of diabetes was also found to be significant with OR 1.48 and CI 95 % (1.20-1.82) P <0.001. On plotting the receiver operating characteristic curve (ROC), the area under the ROC curve to predict the left ventricular function with the model was 0.8137. Conclusions Patients who have higher HbA1C are linked to a higher risk of left ventricular diastolic dysfunction in patients with type 2 diabetes. The combination of diabetes and left ventricular dysfunction can lead to increase morbidity and mortality in those patients in whom it is not identified timely and appropriate measures are not taken. Our work emphasizes the requirement of screening intermittently symptomless diabetic patients for diastolic dysfunction through a Doppler echocardiography so that timely action can be taken.
背景 一些文献表明，2型糖尿病患者临床前舒张功能障碍的患病率很高。本研究旨在确定2型糖尿病患者糖化血红蛋白（HbA1c）水平与左心室舒张功能障碍（LVDD）之间的关联。方法 在贾坎德邦的一家三级医疗保健中心进行了一项观察性横断面研究。2019年4月至2020年9月，在我们中心对100名诊断为2型糖尿病且签署知情同意书并符合纳入和排除标准的受试者进行了研究。进行逻辑回归以确定潜在变量与结果之间的关联。进行多变量逻辑回归分析以确定变量对LVDD预测的独立影响。结果 发现LVDD患者群体的平均HbA1c（11.07±3.66%）高于LVDD正常患者群体（9.11±2.95%），差异具有统计学意义（概率值（P）=0.004）。这表明糖尿病患者中较高水平的HbA1c将导致LVDD的发生率更高。在应用多变量分析确定变量对LVDD的独立影响时，发现HbA1C具有显著性，优势比（OR）为1.26，95%置信区间为1.08 - 1.48。糖尿病病程也具有显著性，OR为1.48，95%置信区间为（1.20 - 1.82），P<0.001。绘制受试者工作特征曲线（ROC）时，该模型预测左心室功能的ROC曲线下面积为0.8137。结论 HbA1C水平较高的患者与2型糖尿病患者左心室舒张功能障碍的较高风险相关。糖尿病和左心室功能障碍的结合可导致未及时识别且未采取适当措施的患者发病率和死亡率增加。我们的工作强调需要通过多普勒超声心动图对无症状糖尿病患者进行间歇性舒张功能障碍筛查，以便能够及时采取行动。
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