Echocardiographic Changes in Type 2 Diabetes Mellitus with Reference to Body Mass Index and Waist Hip Ratio
Background: Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycaemia. India alone had 65.1 million diabetics by the year 2013. DM with high BMI & increased central obesity (WHR) have changes in the cardiac geometry evidenced in echocardiography. AIM OF STUDY: Estimation of Body Mass Index (BMI) and Waist Hip Ratio (WHR) & Establish a relationship between obesity, particularly central obesity in type 2 diabetes mellitus patients and cardiac changes with the help of echocardiography. Methods: 30 Subjects with type 2 DM attending the OPD or admitted in Katihar Medical College indoor department & 30 control patients were also be taken from the same, all of age >40 years. The cases and the controls were examined thoroughly with respect to BMI (>30) & WHR (> 0.85 for females and > 0.95 for males) and echocardiography was done. Results: The cases i.e. type 2 diabetes with high WHR and BMI had highly significant alteration in LV geometry as compared to the controls & had significantly high mean LV mass 189.10grams as compared to 134.04 grams of the controls. There was significant early diastolic dysfunction found in the cases group while no significant difference was found in systolic dysfunction between cases & controls. The incidence of changes in left ventricular geometry was higher in female type 2 diabetic subjects with high waist hip ratio and BMI as compared to males. Conclusions: Form the data of the present study it can be concluded that type 2 diabetics with obesity, particularly central type, have an increased predisposition to the development of left ventricular structural or geometrical abnormality. They have significantly higher left ventricular Mass. Obese type 2 diabetics also have higher incidence of diastolic dysfunction. All these abnormalities occur with greater frequency in females. Thus, type 2 diabetics with high BMI and Waist hip ratio have higher risk of development of cardiovascular disease, which is higher for female than males.
2. IC, A OS, O OJ, U DI. The Relationship between Measures of Obesity and Echocardiographic Determinants of Left Ventricular Hypertrophy in Nigerian Adults. The Internet Journal of Cardiology. 2009 Volume 9 Number 2.
3. Echocardiographic Evaluation of Diastolic Dysfunction in Asymptomatic Type 2 Diabetes Mellitus patients. Journal of Evolution of Medical and Dental Sciences 2014; Vol 3, Issue 01, January 06;
4. American Diabetes Association, Diabetes Care 37 (Suppl 1 ) : S14, 2014
5. UKPDS Research group. UK Prospective Diabetes Study 16.Overview of 6 years therapy of type 2 diabetes; a progressive disease. Diabetes 1995; 44:1249-1258
6. Devereux RB, Alonso DR, Lutas EM, Reichek N et al. Echocardiographic assessment of left ventricular; comparison to necropsy findings. Am J Cardiol 1986 Feb. 15, 57 (6)
7. Ronald MA, Henry, Otto Kamp, Piet J Kostense; Left ventricular Mass increases with deteriorating glucose tolerance, especially in women: Independence of increased arterial stiffness or decreased flow - Mediated Dilation: The Hoorn study, Diabetes care 27: 522-529, 2004.
8. Rutter MK, Parise H, Benjamin EJ, Levy D, et al 2003 Impact of glucose intolerance and insulin resistance on cardiac structure and function; sex related differences in the Framingham Heart Study. Circulation 107: 448-454.
9. Hamby RI, Zoneraich S, Sherman L 1974 Diabetic cardiomyopathy. JAMA 229: 1749-1754.
10. Regan TJ, Lyons MM, Ahmed SS, Levinson GE, et al 1977 Evidence of cardiomyopathy in familial diabetes mellitus. J Clin Invest 60: 884-899.
11. Coughlin SS, Pearle DL, Baughman KL, Wasserman A, Tefft MC 1994 Diabetes mellitus and risk of idiopathic dilated cardiomyopathy. The Washington, DC Dilated Cardiomyopathy Study. Ann Epidemiol 4: 67-74.
12. Friedman NE, Levitsky LL, Edidin DV, Vitullo DA, et al 1982 Echocardiographic evidence for impaired myocardial performance in children with type 1 diabetes mellitus. Am J Med 73: 846-850.
13. Mbanya JC, Sobngwi E, Mbanya DS, Ngu KB 2001 Left ventricular mass and systolic function in African diabetic patients: association with microalbuminuria. Diabetes Metab 27: 378-382.
14. Fang ZY, Yuda S, Anderson V, Short L, Case C, Marwick TH 2003 Echocardiographic detection of early diabetic myocardial disease. J Am Coll Cardiol 41: 611-617.
15. Poirier P, Bogaty P, Garneau C, Marois L, Dumesnil JG 2001 Diastolic dysfunction in normotensive men with well-controlled type 2 diabetes: importance of manoeuvres in echocardiographic screening for preclinical diabetic cardiomyopathy. Diabetes Care 24: 5-10.
16. Tarumi N, Iwasaka T, Inada M et al: left ventricular diastolic filling properties in diabetic patients during isometric exercise, Cardiology 83: 316-323, 1993.