Poor Glycemic Control Associated With Myocardial Fibrosis in Diabetes

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Extracellular volume was significantly larger in patients with HbA1c between 6.5% and 7.5% and HbA1c >7.5% than those with HbA1c <6.5%. <i>Credit: Carolina Biological</i>
Extracellular volume was significantly larger in patients with HbA1c between 6.5% and 7.5% and HbA1c >7.5% than those with HbA1c <6.5%. Credit: Carolina Biological

Myocardial fibrosis may be independently associated with poor glycemic control in adults with diabetes, according to research published in Diabetes Care.

Researchers investigated the link "between glycemic control and measures of macroscopic [left ventricular] remodeling (LV mass) and myocardial fibrosis, measured with cardiac MRI, among adults with diabetes."

Researchers conducted a prospective cross-sectional study of 47 individuals with type 2 diabetes who were being seen at the Corporal Michael J. Crescenz Veterans Affairs Medical Center in Philadelphia, Pennsylvania. Each participant underwent a cardiac MRI to assess left ventricular structure and function and myocardial extracellular volume fraction (ECVF). The study participants were divided into 3 groups based on their hemoglobin A1c (HbA1c) level. There were 12 participants with HbA1c <6.5%, 20 were in the 6.5 to 7.5% range, and 15 were in the >7.5% group.

The researchers adjusted the results for sex, age, blood pressure, BMI, and ECVF, and observed significance for a higher occurrence of myocardial ECFV in individuals with HbA1c levels of 6.5 to 7.5% (27.4% [95% CI, 24.4-30.4]) and >7.5% (28% [95% CI, 24.5-31.5]) than in individuals with levels <6.5% (20.9% [95% CI, 17.1-24.6]; P =.0156). Researchers found no significant differences between groups for LV mass. There was also no significance found between groups for gender differences or differences in blood pressure, antihypertensive medication use, estimated glomerular filtration rates, or cholesterol levels.

The study limitations include that the participant pool was a convenience sample and had limited generalizability (due to most participants being middle-aged or elderly and male).

The researchers noted that additional studies are needed "to investigate the causal role of glycemic control in the development of fibrosis and the molecular mechanisms behind this association. It is important that experimental trials be conducted to assess whether tight glycemic control represents a therapeutic strategy to ameliorate myocardial fibrosis, and its adverse clinical consequences, in human diabetes."

Disclosures: Multiple authors declare affiliations with the pharmaceutical industry. Please see the reference for a complete list of authors' disclosures.

Reference

Al-Badri A, Hashmath Z, Oldland GH, et al. Poor glycemic control is associated with increased extracellular volume fraction in diabetes [published online July 12, 2018]. Diabetes Care. doi: 10.2337/dc18-0324

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