Improved glycemic control induces regression of left ventricular mass in patients with type 1 diabetes mellitus

Background: Diabetes mellitus has been associated with abnormalities of cardiac function and left ventricular hypertrophy. We sought to determine whether improved glycemic control in patients with type 1 diabetes mellitus will induce reversal of those abnormalities. Methods: We prospectively studied 19 patients (mean age 40 +/- 9 years) with longstanding type 1 diabetes mellitus (28 +/- 4 years), who participated in a program of stringent glycemic control. Glycemic control was monitored with hemoglobin A1c levels, and improvement was defined as >1% (absolute) decrease of hemoglobin A1c. Two-dimensional and Doppler echocardiograms and ambulatory 24-h blood pressures were obtained at baseline and after 1 year. Left ventricular mass was determined using the area-length method. Results: In the patients with improved glycemic control (n = 12), hemoglobin A1c decreased from 9.8% to 7.8% (p less than or equal to 0.0001), interventricular septal thickness decreased from 10.3 to 9.4 mm (p less than or equal to 0.05), and left ventricular mass regressed from 205 to 182 g (p less than or equal to 0.05). Septal thickness and left ventricular mass remained unchanged in the patients who did not achieve improvement of glycemic control. Left ventricular internal diameters, posterior wall thickness, fractional shortening, E/A ratio of mitral inflow, E-wave deceleration time (DT), and ambulatory 24-h blood pressures did not change significantly after I year in either group. Conclusions: Improved glycemic control in patients with type I diabetes mellitus is associated with regression of septal thickness and left ventricular mass without significant effect on systolic or diastolic function, in the absence of significant alterations in ambulatory 24-h blood pressures. (C) 2003 Elsevier Ireland Ltd. All rights reserved.