Cardiomyopathy is a familiar yet underappreciated complication of diabetes. Up to 35% of type 2 diabetes patients and about 14.5% of type 1 diabetes patients have some form of cardiac dysfunction, and the risk of cardiomyopathy rises as glycemic control fails.
“Diabetic cardiomyopathy is underappreciated in the clinic because it’s so difficult to find pure diabetic cardiomyopathy not associated with other cardiovascular disease such as coronary artery disease, significant valvular disease, hypertension, or other cardiac diseases,” said Yi Tan, PhD, Associate Professor of Pediatrics, Pharmacology and Toxicology, and the Carol B. McFerran Chair in Pediatric Diabetes Research at the University of Louisville Pediatric Research Institute.
Dr. Tan will review the latest research on the mechanisms that underlie the development of diabetic cardiomyopathy during the symposium Diabetes with Cardiomyopathy—Does Anybody Have a Map? The two-hour session begins at 4:30 p.m. CT Monday, June 6, in Hall E-3 at the convention center.
Dysregulation of glucose and lipid metabolism trigger oxidative stress that can disrupt the normal regulation of cardiomyocyte hypertrophy, resulting in cardiomyocyte loss, cardiac hypertrophy, fibrosis, and increased stiffness well before the onset of measurable cardiac dysfunction, Dr. Tan explained.
“We need to pay more attention to diabetic cardiomyopathy. We need more research and we need more clinical studies,” he said. “There’s no specific treatment for diabetic cardiomyopathy, but we are starting to see some areas of progress.”
One significant area of progress is the development of sodium-glucose cotransporter-2 (SGLT2) inhibitors. Although developed to reduce hyperglycemia by increasing excretion of glucose in the urine, these agents have shown spectacular results in treating heart failure with or without the presence of diabetes.
“SGLT2 inhibitors and GLP-1 (glucagon-like peptide-1) receptor agonists have proven to be revolutionary, with more to come. My sense is we are on the cusp of some really interesting times in cardiomyopathy in diabetes,” said Harold E. Bays, MD, Medical Director and President of the Louisville Metabolic and Atherosclerosis Research Center and Clinical Associate Professor of Medicine at the University of Louisville School of Medicine. “This field is about to get wild in improving multiple aspects of cardiometabolic risk, especially regarding obesity and diabetes. SGLT2 inhibitors and GLP-1 receptor agonists were just the beginning.”
The metabolic benefits of approved and investigational anti-obesity and anti-diabetes agents are not only seen in improved body weight and blood glucose, but also in clinically meaningful improvements in blood pressure and lipids.
“I believe primary care clinicians, specialists, and clinical scientists will welcome this emerging holistic approach, rather than our traditional siloed approach of treating one cardiovascular risk factor at a time,” Dr. Bays said. “We have, and are still developing novel therapeutics that can have a profound effect on glucose, body weight, and other cardiometabolic risk factors, which hopefully will translate into clinically meaningful benefits to the heart. Hyperglycemia is an integral part of diabetes, but managing glucose is not the whole focus for people with diabetes. Within the next two years, we are going to have major new tools to help us treat the entire patient, and not just pieces of the patient.”
Also during the session, Ambarish Pandey, MD, MSCS, will provide recommendations for diagnosing diabetes with cardiomyopathy and Pam R. Taub, MD, will discuss the clinical management of diabetes with cardiomyopathy.