Abstract
BackgroundMany patients with chronic heart failure (CHF) are believed to have unrecognized diabetes, which is associated with a worse prognosis. This study aimed to describe glucose tolerance in a general stable CHF population and to identify determinants of glucose tolerance focusing on body composition and skeletal muscle strength.MethodsA prospective observational study was set up. Inclusion criteria were diagnosis of CHF, stable condition and absence of glucose-lowering medication. Patients underwent a 2 h oral glucose tolerance test (OGTT), isometric strength testing of the upper leg and dual energy x-ray absorptiometry. Health-related quality of life and physical activity level were assessed by questionnaire.ResultsData of 56 participants were analyzed. Despite near-normal fasting glucose values, 55% was classified as prediabetic, 14% as diabetic, and 20% as normal glucose tolerant. Of all newly diagnosed diabetic patients, 79% were diagnosed because of 2 h glucose values only and none because of HbA1c. Univariate mixed model analysis revealed ischaemic aetiology, daily physical activity, E/E’, fat trunk/fat limbs and extension strength as possible explanatory variables for the glucose curve during the glucose tolerance test. When combined in one model, only fat trunk/fat limbs and E/E’ remained significant predictors. Furthermore, fasting insulin was correlated with fat mass/height2 (r = 0.51, p < 0.0001), extension strength (r = -0.33, p < 0.01) and triglycerides (r = 0.39, p < 0.01).ConclusionsOur data confirm that a large majority of CHF patients have impaired glucose tolerance. This glucose intolerance is related to fat distribution and left ventricular end-diastolic pressure.
Highlights
Many patients with chronic heart failure (CHF) are believed to have unrecognized diabetes, which is associated with a worse prognosis
* Correspondence: an.stevens@uhasselt.be †Equal contributors 1REVAL Rehabilitation Research Centre, Hasselt University, Martelarenlaan 42, BE-3500 Hasselt, Belgium Full list of author information is available at the end of the article In CHF patients with reduced systolic function, left ventricular ejection fraction and aetiology of CHF have been described as predictive factors for insulin sensitivity [4,5,6,7,8,9]
Skeletal muscle function has not been investigated in relation to glucose tolerance in CHF yet. Following this line of reasoning, the present study aims to describe glucose tolerance in relation to (a) severity of heart failure, (b) the intake and dosage of typical CHF medical therapies and (c) body composition and skeletal muscle strength in a heterogeneous group of stable CHF patients
Summary
Many patients with chronic heart failure (CHF) are believed to have unrecognized diabetes, which is associated with a worse prognosis. This study aimed to describe glucose tolerance in a general stable CHF population and to identify determinants of glucose tolerance focusing on body composition and skeletal muscle strength. Chronic heart failure (CHF) is a system disease. Apart from cardiac failure, the clinical picture involves pulmonary, renal, hepatic and skeletal muscle abnormalities [1]. The suspicion arises that impaired glucose tolerance is the rule rather than the exception in this population, its exact prevalence is not known [2,3]. Typical CHF medical therapies, i.e. ACE inhibitors , β-blockers and thiazides are believed to influence glucose tolerance [10,11,12,13,14]
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