The Clinical Study Of Type 2 Diabetes Mellitus With Heart Failure

Objective:To evaluate the prevalence, clinical characteristics and risk factors of heart failure (HF) in hospitalized type 2 diabetes mellitus (T2DM) patients. To investigate the alternations of cardiac structure and physiological function in cases of T2DM with HF by Color Doppler Echocardiogram and evaluate the possible factors and mechanisms relating to the change of cardiac structure and function.Methods:1.869 patients diagnosed with T2DM were retrospectively analyzed, and these patients were all admitted in Clinic of HuaShan hospitals in Shanghai during 2004.1.1-2009.5.31.And 396 patients diagnosed with HF in hospital were admitted at the same time. HF was diagnosed by symptoms, physical signs, EKG, chest X-ray, color Doppler Echocardiogram and biochemical indexes.103 patients were excluded from analysis due to co-existing chronic pulmonary heart disease, cardiomyopathies, valvular heart disease and congenital heart disease. We also excluded 307 patients with type 1 diabetes mellitus, impaired glucose tolerance (IGT) and impaired fasting glucose (IFG).2.A total of 869 patients with T2DM were divided into T2DM with HF (n=526) and T2DM without HF (n=343).We calculated the prevalence of HF, systolic heart failure (SHF) and diastolic heart failure (DHF), compared clinical characteristics and analyzed risk factors by multiple Logistic regression.3.A total of 922 patients with HF were divided into SHF (n=104) and DHF (n=818). Then the 104 patients with SHF were further divided into 2 groups:T2DM group (n=60), and non-T2DM group (n=44). And the 818 patients with DHF were also further divided into 2 groups:T2DM group (n=466), and non-T2DM group (n=352).Color Doppler Echocardiogram was performed to all the cases. We analyzed the results of Color Doppler Echocardiogram and clinical data.4. All statistical analyses were performed using SPSS 11.0 software. Results:1.The overall prevalence of HF was 60.52% (526/869) in patients diagnosed as T2DM, among which 6.90% (60/869) was SHF and 53.62% (466/869) was DHF.2.The results revealed that in the group of T2DM with HF, comparing with those without HF, there were more female, elder diabetic patients with longer clinical T2DM duration, higher fasting glucose level, higher HbAlC level, higher prevalence of coronary heart disease (CHD) and hypertension, higher systolic blood pressure (SBP) and lower glomeruar filtration rate (GFR). (P<0.05,P<0.01 or P<0.001).3.The modified multivariate logistic regression analysis found that female (OR=1.64,95% CI:1.04-2.58),elder diabetic patients (OR=1.34,95% CI 1.17-1.53), CHD (OR=1.59,95% CI:1.01～2.49), high fasting glucose level (OR=1.16,95% CI:1.05～1.29) and high HbAlC level (OR=1.33,95% CI: 1.15-1.53)were correlated with increased risk of HF in the final model;while factors as high GFR level (OR=0.98,95 %CI:0.97～0.99) was shown to be reversely correlated with the risk of HF.4.The results revealed that in patients diagnosed as SHF, comparing with non-T2DM patients, T2DM patients showed higher body mass index (BMI), increased SBP and fasting glucose level (P<0.05 or P<0.001).In patients diagnosed as DHF, comparing with non-T2DM patients, T2DM patients were younger with greater BMI, higher SBP and fasting glucose level, higher prevalence of hypertension, higher triglycerides (TG) and lower high-density lipoprotein cholesterol (HDL-C) (P<0.05,P<0.01 or P<0.001).5.Color Doppler Echocardiography showed that SHF with T2DM had higher left ventricular posterior wall thickness dimension (LVPWTd) (P<0.05). And left atria (LA), LVPWTd, interventricular septal thickness dimension (IVSTd), left ventricular mass (LVM) and left ventricular mass index (LVM I) in DHF with T2DM were higher than DHF without T2DM (P<0.01 or P<0.001).Conclusions:1.The T2DM patients tend to develop heart failure, especially the DHF.The risk factors were female, old age, CHD, high FPG and HbAlC, while the protective factor was high GFR level. This implies that it is very important to prevent the incidence of HF by the early and effective controlling of blood glucose level and the prevention of CHD and renal function.2.T2DM combined with HF, especially DHF, are more likely to develop alternations on cardiac structure and function, which is related with greater BMI, higher SBP and fasting glucose level, higher TG and lower HDL-C.The possible mechanism is insulin resistance. This implies that it is very important to prevent greater change of cardiac structure and function by the better and early control of glucose, blood pressure, lipid and body weight.