Diastolic dysfunction more common in young adults with type 2 vs type 1 diabetes
medwireNews: Findings from the SEARCH for Diabetes in Youth study suggest that diastolic dysfunction is prevalent among young adults with type 1 or type 2 diabetes, but those with type 2 diabetes have the highest risk.
Speaking at the virtual ADA 80th Scientific Sessions, Amy Shah (Cincinnati Children’s Hospital Medical Center, Ohio, USA) explained that “diastolic dysfunction is important because it may predict heart failure with preserved ejection fraction [HFpEF],” one of the most common forms of heart failure with “no effective therapies […] except early identification with prevention.”
The study included 479 young adults with type 1 or type 2 diabetes with an average diabetes duration of approximately 11 years. The 258 people with type 2 diabetes had a mean age of 21.2 years and a BMI of 25.9 kg/m2, and 53.9% were female, while the 221 individuals with type 2 diabetes had an average age of 24.8 years and a BMI of 38.0 kg/m2, and 73.8% were female.
Shah said that the people with type 2 diabetes had significantly worse diastolic function than their counterparts with type 1 diabetes regardless of the measurement used. The mean ratio of early flow wave across the mitral valve to the atrial flow wave that occurs after atrial contraction (E/A) was 1.9 in the type 1 diabetes group and 1.6 in the type 2 diabetes group, and the mean ratios of tissue Doppler velocities in early to late diastole (e’/a’) were 1.9 and 1.7, respectively, with lower values corresponding to worse diastolic function for both measures. The corresponding average ratios of early flow wave across the mitral valve to the rate of cardiac wall relaxation in early diastole (E/e’) were 6.3 and 7.6, with higher values indicating worse function.
When compared with a healthy control population of a similar age, Shah said that the prevalence of any abnormal diastolic function was “high in both groups,” but was significantly higher in those with type 2 diabetes, at 57.7% compared with 47.2% in the type 1 diabetes group. Abnormal was defined as an E/A ratio of less than 0.7 or more than 3.0, an e’/a’ ratio of less than 1.5, or an E/e’ ratio of more than 10.0.
Finally, the researchers used a linear adjusted model to investigate predictors of diastolic dysfunction. They identified type 2 diabetes, older age, female sex, non-Caucasian race, higher BMI, higher heart rate, and higher glycated hemoglobin levels as significant predictors.
Noting that some of these risk factors can be modified, Shah concluded: “Given that there are no effective treatments for HFpEF, our data suggest targeting modifiable risk factors may be useful to prevent further diastolic dysfunction.”
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