Effect of tighter glycemic control on cardiac function, exercise capacity, and muscle strength in heart failure patients with type 2 diabetes: a randomized study

Roni Nielsen, Henrik Wiggers, Henrik Holm Thomsen, Ann Bovin, Jens Refsgaard, Jan Abrahamsen, Niels Møller, Hans Erik Bøtker, Helene Nørrelund, Roni Nielsen, Henrik Wiggers, Henrik Holm Thomsen, Ann Bovin, Jens Refsgaard, Jan Abrahamsen, Niels Møller, Hans Erik Bøtker, Helene Nørrelund

Abstract

Objectives: In patients with type 2 diabetes (T2D) and heart failure (HF), the optimal glycemic target is uncertain, and evidence-based data are lacking. Therefore, we performed a randomized study on the effect of optimized glycemic control on left ventricular function, exercise capacity, muscle strength, and body composition.

Design and methods: 40 patients with T2D and HF (left ventricular ejection fraction (LVEF) 35±12% and hemoglobin A1c (HbA1c) 8.4±0.7% (68±0.8 mmol/mol)) were randomized to either 4-month optimization (OPT group) or non-optimization (non-OPT group) of glycemic control. Patients underwent dobutamine stress echocardiography, cardiopulmonary exercise test, 6 min hall-walk test (6-MWT), muscle strength examination, and dual X-ray absorptiometry scanning at baseline and at follow-up.

Results: 39 patients completed the study. HbA1c decreased in the OPT versus the non-OPT group (8.4±0.8% (68±9 mmol/mol) to 7.6±0.7% (60±7 mmol/mol) vs 8.3±0.7% (67±10 mmol/mol) to 8.4±1.0% (68±11 mmol/mol); p<0.001). There was no difference between the groups with respect to changes in myocardial contractile reserve (LVEF (p=0.18)), oxygen consumption (p=0.55), exercise capacity (p=0.12), and 6-MWT (p=0.84). Muscle strength decreased in the non-OPT compared with the OPT group (37.2±8.1 to 34.8±8.3 kg vs 34.9±10.2 to 35.4±10.7 kg; p=0.01), in line with a non-significant decrease in lean (p=0.07) and fat (p=0.07) tissue mass in the non-OPT group. Hypoglycemia and fluid retention did not differ between groups.

Conclusions: 4 months of optimization of glycemic control was associated with preserved muscle strength and lean body mass in patients with T2D and HF compared with lenient control, and had no deleterious effect on left ventricular contractile function and seemed to be safe.

Trial registration number: NCT01213784; pre-results.

Keywords: Glycemic Control; Heart Failure; Stress Echocardiography; Type 2 Diabetes.

Figures

Figure 1
Figure 1
Hemoglobin A1c levels during the study (mean±SEM). The change from baseline to follow-up between groups differed significantly (p

Figure 2

Measurements of myocardial contractile function…

Figure 2

Measurements of myocardial contractile function at rest and during dobutamine stress test (mean±SEM)…

Figure 2
Measurements of myocardial contractile function at rest and during dobutamine stress test (mean±SEM) in each study arm at baseline and follow-up.The change from baseline to follow-up did not differ between study arms with regard to (A) left ventricular ejection fraction (p=0.18), (B) strain (p=0.10), (C) S′max (p=0.32) and (D) wall motion scoring (p=0.35).

Figure 3

Muscle strength—handgrip test. Difference between…

Figure 3

Muscle strength—handgrip test. Difference between baseline and follow-up is shown for each patient…

Figure 3
Muscle strength—handgrip test. Difference between baseline and follow-up is shown for each patient with lines and bars marking mean±SEM for each group. The p value refers to the difference in delta value between groups.
Figure 2
Figure 2
Measurements of myocardial contractile function at rest and during dobutamine stress test (mean±SEM) in each study arm at baseline and follow-up.The change from baseline to follow-up did not differ between study arms with regard to (A) left ventricular ejection fraction (p=0.18), (B) strain (p=0.10), (C) S′max (p=0.32) and (D) wall motion scoring (p=0.35).
Figure 3
Figure 3
Muscle strength—handgrip test. Difference between baseline and follow-up is shown for each patient with lines and bars marking mean±SEM for each group. The p value refers to the difference in delta value between groups.

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