The Impact of Diabetes Reversal on Myocardial Function and Quality of Life in Diabetic Cardiomyopathy -A Prospective Research Study

Abstract

Introduction: Diabetes mellitus and its related consequences impose a significant worldwide cost on human health and economic resources. Cardiovascular illnesses are the primary cause of mortality among those with diabetes, who face a 2- to 5-fold increased likelihood of developing heart failure compared to non-diabetic individuals of the same age, regardless of any coexisting medical conditions. Diabetic cardiomyopathy refers to the manifestation of atypical heart structure and impaired cardiac function in the absence of other risk factors commonly associated with cardiac conditions, such as coronary artery disease, hypertension, and notable valve abnormalities. The density of patients with diabetic cardiomyopathy is rising progressively. Even now, the focus is more on diabetes blood sugar management, diabetic nephropathy, diabetic neuropathy, and poor quality of life; diabetic cardiomyopathy needs to be more pronounced in the treatment- guidelines; very few studies have been conducted on diabetic cardiomyopathy. Methods: This prospective study was initiated in January 2021, was conducted for 18 months, and was completed in June 2022. This study is a prospective study of diabetic patients with manifested diabetic cardiomyopathy, the effect of an integrated approach of dietary modification and guided exercise protocol enhancing cardiac performance and the quality of life. The patients satisfying the inclusion criteria without exclusion criteria were randomized to intervention and control groups. Results: The age group of the mean (years) ± SD (58.41±10.43) in the Intervention Group and (56.87±11.23.) in the Control Group. Both the groups comprised female participants, 39% in the Intervention Group and 27% in the Control Group. The initial evaluation was done at the beginning of this prospective study. The follow-ups were done in 1, 3, 6, 9, 12, and 18 months. Clinical examination, peak VO2 evaluation in a cardiopulmonary exercise test, and echocardiography with Left Ventricular Global Longitudinal Strain (LV-GLS) measurements. During the study period, it was noted that there were substantial improvements in HbA1C, low-density lipoprotein (LDL), peak VO2, and Quality of Life (QoL). Conclusion: In Conclusion, based on the findings of this prospective study, the integrated approach of nutritional modification and guided exercise protocol in diabetic cardiomyopathy with or without heart failure patients has tremendous benefits in cardiac performance and remarkable improvement in QoL. As the life span improves, that leads to more heart failure patients presently and in the future. Along with pharmacotherapy against diabetes, diabetes reversal should be emphasized from the beginning of diabetes diagnosis to achieve a better quality of life. Considering the importance of a guided diabetes reversal program through this study, it would not be wrong to suggest it as an initial treatment strategy in case of diabetes with or without diabetic cardiomyopathy manifestations.