Heart Failure in Type-2 Diabetes and The Impact of Lifestyle Interventions

Background

People with T2D are at high risk of developing HF and even when asymptomatic often have subclinical cardiovascular structure and function abnormalities (stage-B HF). Approximately 50% of HF patients have HFpEF. Lifestyle modifications may be useful to manage HFpEF by treating the comorbidities closely linked with HFpEF development and progression, including obesity and T2D.

Methods

1. Secondary analyses of the DIASTOLIC trial

a. Case-control of micronutrient concentrations in T2D (N=119)

b. Associations between change in micronutrient concentration and cardiovascular structure and function (N=54)

c. Case-control of novel CPET variables in T2D (N=120)

d. Baseline associations between CPET indices of exercise tolerance and abnormal cardiovascular structure and function (N=84)

e. Effects of lifestyle interventions on novel CPET variables in T2D (N=72)

2. Development of exercise-CMR in healthy volunteers (N=6)

3. Systematic review and network meta-analyses of lifestyle interventions in HFpEF

4. Feasibility of a low-energy MRP in obese HFpEF (N=3)

Results

Compared to matched healthy controls, concentrations of vitamins B1 and B6 differ in T2D, and CPET indices of exercise tolerance are reduced.

A 12-week low-energy MRP improves vitamins B1, B6, D, and C, and heart rate recovery. Impaired CPET indices of exercise tolerance are associated with abnormal cardiovascular structure and function in T2D. Change in micronutrient concentration and change in cardiovascular structure and function are not associated.

Lifestyle interventions improve VO2peak and QoL in HFpEF. HIIT was the most effective intervention.Recruitment to a low-energy MRP in HFpEF was impacted by the covid-19 pandemic. Three participants were recruited and completed the study. Therefore, retention and completion may be feasible, but a larger study is required to confirm feasibility and efficacy.

Conclusion

Lifestyle interventions can improve patient-centred outcomes in T2D and HFpEF. The feasibility of applying a pragmatic low-energy MRP in HFpEF requires further investigation to confirm acceptability and efficacy.