Influence of the glucose-lowering rate on left ventricular function in patients with type 2 diabetes and coronary heart disease

Background: The optimal methods for glucose control and reduction in the risk of cardiovascular disease are controversial. Findings from recent clinical trials have shown different viewpoints on the advantages and disadvantages of intensive lowering of glucose. We used echocardiography to explore the influence of the glucose-lowering rate on left ventricular function in patients with type 2 diabetes mellitus (T2DM). We also attempted to discover an effective glucose-lowering rate for patients with type 2 diabetes mellitus and coronary heart disease (T2DM-CHD). Methods: A total of 132 cases of T2DM and 135 cases of T2DM-CHD received intensive glucose therapy. After measuring left ventricular ejection fraction (LVEF) and the E/A ratio, variations and correlation factors were evaluated. Results: LVEF was significantly higher than before intensive therapy in the T2DM group with a glucose-lowering rate of <= 6 mmol.L-1.d(-1) (P<.05). LVEF was significantly lower than before intensive therapy in the T2DM-CHD group with a glucose-lowering rate >4 mmol.L-1.d(-1) (P<.05), whereas at the end of follow-up (3 months), LVEF increased and no significant difference was observed between subgroups (P>.05). The E/A ratio increased among all subgroups after intensive therapy (P<.05). The waist-hip ratio, duration of T2DM, and age had a linear regression relationship with variations in LVEF before and after intensive therapy. Conclusions: For patients with T2DM and CHD, an excessively fast glucose-lowering rate could impair left ventricular systolic function. Long-term, good control of blood glucose could restore the impaired left ventricular systolic function caused by an excessively fast glucose-lowering rate. After intensive therapy, left ventricular diastolic function improved among all subgroups regardless of the glucose-lowering rate and CHD. (C) 2012 Elsevier Inc. All rights reserved.