Impact of the Remission of Type 2 Diabetes on Cardiovascular Structure and Function, Exercise Capacity and Risk Profile: A Propensity Matched Analysis

Type 2 diabetes (T2D) confers a high risk of heart failure with structural and functional cardiovascular abnormalities often present before symptom onset. The effects of remission of T2D on cardiovascular structure and function are unknown. This study describes the impact of T2D remission, beyond weight loss and glycaemia, on cardiovascular structure and function and exercise capacity. Adults with T2D without cardiovascular disease underwent multimodality cardiovascular imaging, cardiopulmonary exercise testing, and cardiometabolic profiling. T2D remission cases (HbA1c < 6.5% without glucose-lowering therapy for ≥3 months) were propensity score matched 1:4 to those with active T2D (n = 100) based on age, sex, ethnicity and exposure time, and 1:1 with non-T2D controls (n = 25). T2D remission was associated with a lower leptin–adiponectin ratio, lower hepatic steatosis and triglycerides, a trend towards greater exercise capacity, and a significantly lower VE/VCO2 slope versus active T2D (27.74 ± 3.95 vs. 30.52 ± 5.46, p < 0.0025). Evidence of concentric remodeling remained in T2D remission versus controls (left ventricular mass/volume ratio 0.88 ± 0.10 vs. 0.80 ± 0.10, p < 0.025). T2D remission is associated with an improved metabolic risk profile and ventilatory response to exercise without concomitant improvements in cardiovascular structure or function. Continued attention to risk factor control is required for this patient population.

Joanna M Bilak, Jian L Yeo, Gaur S Gulsin, Anna-Marie Marsh, Manjit Sian, Abhishek Datta, Sarah L Ayton, Kelly S Parke, Moira Bain, Wenjie Pang, Sherif Boulos, Tim G St Pierre, Melanie J Davies, Thomas Yates, Gerry P Mccann, Emer M Brady