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Journal of Medical Sciences

Year: 2007 | Volume: 7 | Issue: 5 | Page No.: 783-789
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Authors

Inas Abdul-Sattar Saad

Tarek Salah Ibrahim

Keywords

Research Article

Effect of Glycemic Control on the Progress of Left Ventricular Hypertrophy and Diastolic Dysfunction in Children with Type I Diabetes Mellitus

Inas Abdul-Sattar Saad and Tarek Salah Ibrahim
The present research evaluated the progression of left ventricular structural and functional changes in children and adolescent patients with type I DM and the effect of glycemic control on these changes. A Prospective, case-controlled, observational study was carried out in tertiary referral hospital in Holly Makkah-KSA including 135 young patients with type I DM recruited from the endocrinology clinic and were followed up in the hospital cardiac center unit. Patients were divided into 2 groups: group composed of 46 patients with type I DM and left ventricular hypertrophy (LVH+ve group) compared to another group, composed of 89 patients with type I DM but had a normal left ventricular echocardiographic parameters (LVH -ve group). All the studied patients were subjected to full history taking, clinical and cardiac examination. Electrocardiogram, laboratory tests for glycosylated hemoglobin, lipid profile, albuminuria and careful ecocardiographic examination were done. All patients were followed up and participated in a program for glycemic control. Echocardiographic follow-up was done thoroughly again for patients who had left ventricular hypertrophy (LVH) after two years. Our results showed that echocardiographic parameters after 2 years follow up showed statistically significant difference regarding cardiac structural and functional parameters in favor for the patients in group who achieved glycemic control. Also comparing echocardiographic parameters of those patients who achieved glycemic control to their baseline results showed that mean value of interventricular septal dimension (IVSd) decreased from 1.12cm to 1.03 (p = 0.04), posterior wall dimension (PWd) decreased from 1.07-0.97 (p = 0.05) however diastolic dysfunction represented by isovolumic relaxation time (IVRT) and E/A did not show a statistically significant change. Patients who did not achieve glycemic control showed worsening of their echocardiographic parameters: IVSd increased significantly (p = 0.01), E/A ratio showed a significant decrease (p = 0.006) and IVRT significantly increased (p = 0.04). We concluded that good glycemic control in diabetic patients could improve some structural parameters of the heart while failure to achieve glycemic control leads to deterioration in functional and structural parameters of the heart. Follow up and early detection of myocardial structural and functional changes in young patients with type I DM contribute to better knowledge of diabetic cardiomyopathy and may help to prevent the natural progression of the disease.
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