The incidence of diabetes mellitus (DM) is increasing worldwide and rapidly assuming epidemic proportions. Over the last three decades, several epidemiological, clinical and autopsy studies have proposed the presence of diabetic heart disease as a distinct clinical entity ¹. Diastolic failure is also referred to as heart failure with preserved left ventricular systolic function. Many studies have reported that the incidence of heart failure in diabetic subjects is high, even in the absence of hypertension and coronary artery disease. Studies have reported a prevalence of preclinical diabetic dysfunction among subjects with diabetes mellitus.

The evidence indicates that myocardial damage in diabetic subjects affects diastolic function before the systolic function. Diabetic cardiomyopathy has been proposed as an independent cardiovascular disease, and many mechanisms, such as microvascular disease, autonomic dysfunction, metabolic disorders, and interstitial fibrosis, have been suggested as causative factors ². This study will determine any association between diastolic dysfunction and type 2 DM in the asymptomatic subjects and its relation to glucose triad, i.e., HbA1C, fasting blood sugar, and Postprandial blood sugar.

Diabetic cardiomyopathy has been identified as a distinct entity characterised by the presence of abnormal myocardial performance or structure in the absence of epicardial coronary artery disease, hypertension and significant valvular disease ^3,4. A reduction of LV compliance – an early sign of DM cardiomyopathy may already be deductible early in the course of DM. The pathogenic mechanisms involve accumulating advanced glycation products, collagen formation, and interstitial fibrosis, leading to impaired calcium hemostasis and myocardial insulin signalling. These perturbations increase myocardial stiffness and reduce myocardial compliance, and further, the myocardial dysfunction may progress.

The study was done in the Department of General Medicine, Chalmeda Ananda Rao Institute of Medical Sciences, Karim Nagar, Telangana.

STUDY DESIGN: This is a hospital-based cross-sectional study.

STUDY PERIOD: The present study was conducted for one year.

SOURCE OF DATA: Patients with a history of Type 2 DM, as per American Diabetes Association guidelines, with a minimum duration of diabetes mellitus of 5 years.

SAMPLE SIZE: A total of 100 patients with Type 2 DM

INCLUSION CRITERIA:

• Age group 30-55 years independent of
• Patients with a history of Type 2 DM for at least 5

EXCLUSION CRITERIA:

• Subjects with evidence of coronary artery
• Hypertensive patients
• Subjects with evidence of valvular disease
• Subjects with thyroid
• Subjects with peripheral vascular
• Patients aged above 55
• Patients with established ischaemic heart

ETHICAL CLEARANCE:

Before the commencement, ethical clearance was obtained from the Institutional Ethics Committee for the study.

DIASTOLIC DYSFUNCTION:

The diastolic dysfunction was evaluated using Doppler Echocardiography. In Doppler Echocardiography, the following values were studied.

• E - peak velocity of early mitral
• A – peak velocity of late mitral
• E/A
• IVRT – Isovolumic relaxation
• LVDID – Left ventricular diameter in
• LVDIS - Left ventricular diameter in
• EF – Ejection

The present one-year hospital-based cross-sectional study was done in the Department of General Medicine. A total of 100 patients diagnosed with Type 2 DM were randomly studied.

In the present study, most patients (49%) had FBS levels between 100-125mg/dL, 39% had FBS levels of ³ 126mg/dL, and 12% had FBS levels <100mg/dL. The mean FBS levels were 135.93±36.01mg/dL, and median FBS levels were 124.5mg/dL, with a range of 60mg/dL being minimum and 220mg/dL being maximum. In this study, diastolic dysfunction was comparable in patients with fasting blood sugar levels of <100mg/dL (58.33%), 100-125mg/dL (65.31%), and ³ 126mg/dL (51.28%).

Diabetic individuals have been reported to develop congestive heart failure in the absence of coronary artery disease, hypertension or any structural disease. The term diabetic cardiomyopathy has been introduced for this condition.

The early and commonest hemodynamic derangement of diabetic cardiomyopathy is left ventricular diastolic dysfunction followed by systolic dysfunction. Left ventricular diastolic dysfunction represents the reversible first stage of diabetic cardiomyopathy, reinforcing the importance of evaluation for early examination of diastolic ventricular function in patients with DM. Myocardial involvement in diabetes mellitus may occur early in the course of the disease, which impairs early diastolic relaxation initially and causes decreased myocardial contraction when it becomes more extensive.

The prevalence of diabetes is reported to be higher in men than women ^5-11. In the present study, most patients were males (63%), and the male-to-female ratio was 1.7:1, consistent with the previous literature ^5-11.

Recently, Dixit N.M. et al.¹², in their case-control study from Surat, India, reported a prevalence of diastolic dysfunction in as high as 66% of the normotensive diabetic patients. Patil and Burji¹³ from Mysore, Karnataka, reported a similar rate of diastolic dysfunction, where 64% of subjects with type 2 DM had diastolic dysfunction.

Exiaria et al.,¹⁴, reported 63.2% of patients with diastolic dysfunction in their study of 114 subjects, compared to our prevalence of 59%. Boyer et.al¹⁵ stated that the prevalence of LV diastolic dysfunction in asymptomatic normotensive patients with type 2 Diabetes disease is high. Diastolic dysfunction was found in 75% of subjects.

Overall, this study demonstrates that the incidence of diastolic dysfunction in patients with type 2 DM is high to the extent that every 3rd individual with DM may present with diastolic dysfunction.

The present study reveals a high incidence of diastolic dysfunction in asymptomatic type 2 DM patients. The prevalence of diastolic dysfunction in patients with type 2 DM is 59%. Patients with type 2 DM who have diastolic dysfunction are likely to present with raised FBS levels. Hence, controlling diabetes, viz., glucose triad, i.e., HbA1C, FBS, PPBS, may prevent or postpone diastolic dysfunction in type 2 DM patients.