BACKGROUND Type 2 diabetes mellitus (T2DM) is a major cause of heart failure (HF) with preserved ejection fraction (HFpEF), usually presenting as left ventricular (LV) diastolic dysfunction. Thus, LV diastolic function should be considered a crucial marker of a preclinical form of DM-related cardiac dysfunction. However, the impact of glycemic variability (GV) on LV diastolic function in such patients remains unclear. METHODS We studied 100 asymptomatic T2DM patients with preserved LV ejection fraction (LVEF) without coronary artery disease (age: 60 ± 14 years, female: 45%). GV was evaluated as standard deviation of blood glucose level using continuous glucose monitoring system for at least 72 consecutive hours. LV diastolic function was defined as mitral inflow E and mitral e' annular velocities (E/e'), and > 14 was determined as abnormal. RESULTS E/e' in patients with high GV (≥ 35.9 mg/dL) was significantly higher than that in patients with low GV (11.3 ± 3.9 vs. 9.8 ± 2.8, p = 0.03) despite similar age, gender-distribution, and hemoglobin A1c (HbA1c). Multivariate logistic regression analysis showed that GV ≥ 35.9 mg/dL (odds ratio: 3.67; 95% confidence interval: 1.02-13.22; p < 0.05) was an independently associated factor, as was age, of E/e' > 14. In sequential logistic models for the associations of LV diastolic dysfunction, one model based on clinical variables including age, gender and hypertension was not improved by addition of HbA1c (p = 0.67) but was improved by addition of high GV (p = 0.04). CONCLUSION Since HFpEF is a syndrome caused by diverse agents, reducing GV may represent a potential new therapeutic strategy for the prevention of the development of HFpEF in T2DM patients.

中文翻译：

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2型糖尿病患者血糖变异性与左心室舒张功能的关系。

背景技术2型糖尿病（T2DM）是具有保留的射血分数（HFpEF）的心力衰竭（HF）的主要原因，通常表现为左心室（LV）舒张功能障碍。因此，LV舒张功能应被视为DM相关心脏功能障碍的临床前形式的关键标志。但是，这种患者的血糖变异性（GV）对左室舒张功能的影响尚不清楚。方法我们研究了100例无症状T2DM患者，这些患者的LV射血分数（LVEF）保持不变而无冠心病（年龄：60±14岁，女性：45％）。使用连续血糖监测系统至少连续72小时将GV评估为血糖水平的标准差。左室舒张功能定义为二尖瓣流入E和二尖瓣e'的环形速度（E / e'），并且> 14个被确定为异常。结果尽管年龄，性别分布和性别相似，但GV较高（≥35.9 mg / dL）的患者的E / e'显着高于GV较低的患者（11.3±3.9 vs. 9.8±2.8，p = 0.03）。血红蛋白A1c（HbA1c）。多元逻辑回归分析显示，GV≥35.9 mg / dL（几率：3.67； 95％置信区间：1.02-13.22； p <0.05）是与年龄相关的E / e'> 14的独立相关因素。 LV舒张功能障碍相关性的顺序逻辑模型，一种基于临床变量（包括年龄，性别和高血压）的模型不能通过添加HbA1c来改善（p = 0.67），但是可以通过添加高GV来改善（p = 0.04）。结论由于HFpEF是由多种药物引起的综合征，