Grigorescu Elena-Daniela, Lăcătușu Cristina-Mihaela, Floria Mariana, Cazac Georgiana-Diana, Onofriescu Alina, Sauciuc Livia-Amira, Ceasovschih Alexandr, Crețu Ioana, Mihai Bogdan-Mircea, Șorodoc Laurențiu
Unit of Diabetes, Nutrition and Metabolic Diseases, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania.
Clinical Center of Diabetes, Nutrition and Metabolic Diseases, "Sf. Spiridon" County Clinical Emergency Hospital, 700111 Iași, Romania.
Diagnostics (Basel). 2023 Aug 31;13(17):2817. doi: 10.3390/diagnostics13172817.
Left ventricular diastolic dysfunction (DD) is a subclinical cardiac abnormality in patients with type 2 diabetes mellitus (T2DM) that can progress to heart failure (HF) and increase cardiovascular risk. This prospective study evaluated the DD in T2DM patients without atherosclerotic cardiovascular disease after one year of incretin-based drugs added to standard treatment. Of the 138 enrolled patients (49.30% male, mean age 57.86 ± 8.82, mean T2DM history 5 years), 71 were started on dipeptidyl peptidase-4 inhibitor sitagliptin/saxagliptin, 21 on glucagon-like peptide-1 receptor agonist exenatide, and 46 formed the control group (metformin and sulphonylurea/acarbose). At baseline, 71 patients had grade 1 DD, another 12 had grade 2 and 3 DD, and 15 had indeterminate DD. After one year, DD was evidenced in 50 cases. Diastolic function improved in 9 cases, and 27 patients went from grade 1 to indeterminate DD. The active group benefited more, especially patients treated with exenatide; their metabolic and inflammation profiles also improved the most. An in-depth analysis of echocardiographic parameters and paraclinical results in the context of literature data justifies the conclusion that early assessment of diastolic function in T2DM patients is necessary and the benefits of affordable incretin-based treatment may extend to subclinical cardiovascular manifestations such as DD.
左心室舒张功能障碍（DD）是2型糖尿病（T2DM）患者中的一种亚临床心脏异常，可进展为心力衰竭（HF）并增加心血管风险。这项前瞻性研究评估了在标准治疗基础上加用肠促胰岛素类药物一年后，无动脉粥样硬化性心血管疾病的T2DM患者的舒张功能障碍情况。在138名入组患者中（男性占49.30%，平均年龄57.86±8.82岁，平均T2DM病史5年），71名患者开始使用二肽基肽酶-4抑制剂西他列汀/沙格列汀，21名使用胰高血糖素样肽-1受体激动剂艾塞那肽，46名组成对照组（二甲双胍和磺脲类药物/阿卡波糖）。基线时，71名患者有1级舒张功能障碍，另外12名有2级和3级舒张功能障碍，15名舒张功能障碍情况不确定。一年后，50例患者出现舒张功能障碍。9例患者舒张功能改善，27名患者从1级转变为舒张功能障碍情况不确定。治疗组获益更多，尤其是接受艾塞那肽治疗的患者；他们的代谢和炎症指标改善也最为明显。结合文献数据对超声心动图参数和辅助检查结果进行深入分析后得出结论，对T2DM患者进行舒张功能的早期评估是必要的，且价格合理的肠促胰岛素类治疗的益处可能会扩展到诸如舒张功能障碍等亚临床心血管表现。
