Impact of remission of type 2 diabetes on cardiovascular structure and function, exercise capacity and risk profile: a propensity matched analysis

Background and aims: Type 2 diabetes (T2D) confers high risk of heart failure frequently with evidence of cardiovascular structural and functional abnormalities before symptom onset. The effects of remission of T2D on cardiovascular structure and function are unknown. The aim of this work was to describe the impact of remission of T2D, beyond weight-loss and glycaemia, on cardiovascular structure and function and exercise capacity.

Materials and methods: Obese adults with T2D without cardiovascular disease were recruited into the "Prevalence and determinants of subclinical cardiovascular dysfunction in adults with type 2 diabetes" study (PREDICT). PREDICT is a prospective cross-sectional, case-control study. All participants underwent multimodality cardiovascular imaging, cardiopulmonary exercise testing, and cardiometabolic profiling. T2D-remission cases (HbA1c <6.5% without glucose-lowering therapy, ≥3 months) were identified at recruitment and were propensity score matched 1:4 based on age, sex, ethnicity, and time of exposure to those with active-T2D (n=100) with the nearest neighbour method and 1:1 with non-T2D controls (n=25) based on age, sex, and ethnicity. Between-group comparisons were made (T2D-remission vs. active-T2D and T2D-remission vs. non-T2D control).

Results: The average exposure to T2D was less than six years across both groups and the duration of remission was 4.2±2.5 years. The variance between groups for demographic, anthropometry and metabolic profile was expected based on the study design. T2D-remission was associated with lower leptin-adiponectin ratio (0.75 (0.37,1.50) vs. 2.24 (1.43,4.10)), hepatic steatosis (3.20% (2.20,7.33) vs. 9.40 (4.80,15.20)) and triglycerides (1.45mmol/l (0.96,1.74) vs. 1.69 (1.3,2.2)), a trend towards greater exercise capacity and significantly lower VE/VCO2 slope vs. active-T2D (27.74 ± 3.95 vs. 30.52 ± 5.46) all p<0.0025. Evidence of concentric remodeling remained in T2D-remission vs. controls (left ventricular mass/volume ratio 0.88 ± 0.10 vs. 0.80 ± 0.10, p<0.025).

Conclusion: T2D-remission is associated with improved metabolic risk profile and ventilatory response to exercise without concomitant improvements in cardiovascular structure or function. There is a requirement for continued attention to risk factor control for this important patient population.