| Background:Heart failure（HF）is a clinical syndrome caused by abnormal heart structure or function,and is the end stage of various cardiovascular diseases.An epidemiological survey of heart failure in China in 2003showed that the prevalence of heart failure among adults aged 35 to 74 years in my country was 0.9%[1].Heart failure is divided into left ventricular ejection fraction:heart failure with reduced ejection fraction（HFr EF）,heart failure with median ejection fraction（HFmr EF）,and heart failure with preserved ejection fraction（HFp EF）[1].According to the results of the epidemiological survey of China’s hospitalized heart failure patients released in 2019[2],HFp EF patients accounted for 43%of my country’s hospitalized heart failure patients.Studies[3]have shown that heart failure with preserved ejection fraction accounts for almost 50%of heart failure.Diabetes（diabetes mellitus,DM）is a group of disorders of carbohydrate,protein,and fat metabolism disorders caused by insufficient or relative secretion of insulin and/or impaired insulin utilization.Hyperglycemia is the main sign.Diabetes is a common and frequently-occurring disease.At present,the prevalence and incidence of diabetes have risen sharply globally.According to the statistics of the International Diabetes Federation（IDF）in 2017,there are 425 million adults with diabetes worldwide.The prevalence of diabetes among women aged 20-79 is about 8.4%,and the prevalence among men is about9.1%.It is estimated that by 2045,diabetics may reach 629 million.The prevalence of diabetes in my country is also showing a rapid growth trend.In 2017,there were 114 million diabetic patients in China’s20-79 year-old population,ranking first in the world.Diabetes is divided into type 1 diabetes,type 2diabetes,and special types of diabetes.Type 2 diabetes accounts for about 95%of diabetic patients,and its incidence is increasing year by year.The prevalence of diabetes in adults aged 18 and above in my country has reached about 10%[4,5].T2DM exists in almost half of HFp EF patients,and its presence plays an important role in the development of HFp EF[6].In addition,type 2 diabetes has nearly tripled the morbidity and mortality of HFp EF patients[7].Although there is a lack of evidence that strict glycemic control can reduce the incidence of cardiovascular events,there is increasing evidence that the choice of hypoglycemic agents may affect the prognosis of HF.Objective:To study the correlation between the use of insulin and the progress of cardiac function in patients with T2DM combined with HFp EF compared with metformin.Methods:In this study,an observational study was adopted.From December 2017 to December 2018,200T2DM patients with HFp EF and HFp EF hospitalized in Henan Provincial People’s Hospital were selected for 1-year follow-up.According to the different choices of hypoglycemic drugs,it is divided into a simple insulin treatment group（n1）and a simple metformin treatment group（n2）.Instruct patients to pay attention to monitoring blood pressure and blood sugar regularly,and regularly review glycated hemoglobin and blood lipids.The clinical data,laboratory examination results,echocardiographic indicators,electrocardiographic indicators,and medication use of the two groups of patients within 1 year were collected by We Chat and telephone follow-up.Among them,99 cases were excluded due to severe comorbidities or poor blood glucose,blood lipids,poor blood pressure control,incomplete data,or lost to follow-up.A total of 101 patients were enrolled.Results:1.A total of 101 cases were included in this study,the insulin-only treatment group（n1）and the metformin-only treatment group（n2）,of which 43 were in the n1 group and 58 were in the n2 group.Analysis of the general data of the two groups of patients revealed that there were no significant differences in age,gender,BMI,hypertension,coronary heart disease,hypertrophic cardiomyopathy,atrial fibrillation,NYHA grade,and HFp EF course at baseline,P>0.05.However,there was a difference in the course of T2DM between the two groups.The diabetes course in the insulin treatment group was longer than that in the metformin treatment group,P<0.001,and the difference was statistically significant.2.Analyze the laboratory test results of NT-pro BNP,Hb A1c,creatinine,c Tn I,CK-MB,TG,TC,HDL-C,LDL-C at baseline in the two groups of patients.P>0.05.3.The baseline echocardiographic indexes LVEF,LVEDV,and left and right anterior and posterior diameters of the two groups were not significantly different,P>0.05.There was no significant difference in ECG index QRS≥120ms,pathological Q wave,LBBB,RBBB between the two groups at baseline,P>0.05.4.There was no significant difference in the use ofβ-blockers,ACEI/ARBs,aldosterone receptor antagonists,diuretics,CCB and other drugs at baseline,P>0.05.5.After one year of follow-up between the two groups,46 patients were admitted to the hospital again due to worsening heart failure,including 25 cases in the n1 group and 21 cases in the n2 group.Comparing the changes in LVEF,LVEDV,anterior-posterior diameter of the left atrium,NT-pro BNP,NYHA classification of the two groups of patients after 1 year,there was no significant difference between the two groups.However,there was a difference between the two groups in the rate of re-admission to worsening heart failure.Patients in the insulin treatment group had a higher rate of re-admission to heart failure,the difference was statistically significant,P<0.05.6.A total of 101 cases were divided into non-admission group（n3）and re-admission group（n4）according to whether they were re-admitted due to worsening heart failure within 1 year.Among them,55people in n3 group and 46 people in n4 group.The clinical characteristics of the two groups were analyzed.Among them,9 factors were found at baseline:insulin therapy,age,NYHA class II,NYHA class IV,QRS wave≥120ms,LBBB,atrial fibrillation,the course of T2DM,the course of HFp EF and the cause of T2DM patients with HFp EF The worsening of heart failure is related to hospital admission again,P<0.05.7.Multivariate logistic regression analysis was performed on nine factors including insulin treatment at baseline,age,NYHA class II,NYHA class IV,QRS wave≥120ms,LBBB,atrial fibrillation,T2DM disease course,and HFp EF disease course,and the age was found（OR1.173,95%CI1.061-1.298,p=0.002）,atrial fibrillation（OR8.463,95%CI 1.562-45.866,p=0.013）,course of T2DM（OR1.860,95%CI1.194-2.897,p=0.006）,QRS≥120ms（OR32.852,95%CI 3.614-298.589,p=0.002）is an independent risk factor for hospitalization due to worsening heart failure within 1 year.The use of insulin therapy（OR2.425,95%CI 0.511-11.512,p=0.265）is not an independent risk factor for re-admittance to worsening heart failure within 1 year.Conclusion:For patients with heart failure in T2DM patients with HFp EF,the two groups of general information,auxiliary examinations,and medications are not much different.After 1 year of follow-up,we found that although the hospitalization rate and mortality rate of patients in the insulin treatment group Higher,but after excluding the interference of T2DM course,age,atrial fibrillation,QRS wave≥120ms and other factors,it was found that the use of insulin did not increase the hospitalization rate of patients with heart failure. |
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