Correlation Between Insulin Resistance Assessment Indicators And Subclinical Left Ventricular Dysfunction In Type 2 Diabetes Mellitus

Objectives To investigate the clinical features of subclinical left ventricular dysfunction(SLVD)in patients with type 2 diabetes mellitus.To determine the correlation between insulin resistance assessment indicators and SLVD in patients with type 2 diabetes mellitus.Methods The medical records of patients with type 2 diabetes mellitus hospitalized in the Department of Endocrinology of Nanjing Drum Tower Hospital from March 2021 to July 2022 were retrospectively collected.Medical records were screened according to predetermined inclusion and exclusion criteria,and 183 patients were identified.According to the global longitudinal strain(GLS)measured by speckle-tracking echocardiography,the subjects were divided into SLVD group(GLS<18%)and nonSLVD group(GLS≥18%).Independent sample t test and Mann-Whitney U test were used to compare the differences in clinical data between SLVD group and non-SLVD group,including:the general characteristics,laboratory examination indexes,echocardiographic indexes and insulin resistance assessment indicators of the patients were analyzed,and the multivariate logistic regression model was used to analyze the relationship between the insulin resistance assessment indicators and SLVD in type 2 diabetes mellitus patients.Subgroup analysis was performed after separating the patients according to age,sex,HbAlc,and statin use.Results Compared with the non-SLVD group,the SLVD group had a higher proportion of males,body mass index,waist circumference and waist-to-hip ratio.In terms of laboratory tests,the SLVD group had higher fasting C-peptide and triglyceride levels.In terms of cardiac structure and function,end-diastolic interventricular septal thickness,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,left ventricular end-diastolic posterior wall thickness,and left atrium diameter were higher.The left ventricular ejection fraction and GLS were lower.In terms of insulin resistance assessment indicators,the triglyceride-glucose(TyG)index,homeostasis model assessment-2 of insulin resistance,metabolic score for insulin resistance,lipid accumulation product,visceral adiposity index and Chinese visceral adiposity index were higher,and the differences were statistically significant.Multivariate logistic regression analysis,adjusted for age,sex,body mass index and traditional cardiovascular risk factors(systolic blood pressure,diastolic blood pressure,glycosylated hemoglobin and low-density lipoproteincholesterol),found that TyG index was an independent risk factor for SLVD in patients with type 2 diabetes mellitus(OR=1.781,95%CI 1.032-3.073,P=0.038).This independent association remained significant in the subgroups of male,age<45 years,HbA1c≥7%and without stain use after multivariable adjustment.The results of correlation analysis showed that TyG index was positively correlated with body mass index,waist circumference,systolic blood pressure,diastolic blood pressure,fasting plasma glucose,glycosylated hemoglobin,triglyceride,total cholesterol and fasting C-peptide,and negatively correlated with high-density lipoprotein and GLS(P<0.05).Conclusion Studies have shown that type 2 diabetes mellitus patients with SLVD have more significant insulin resistance than those without SLVD.As an independent risk factor for SLVD,elevated TyG index may have reference significance for identifying the risk of cardiovascular disease and guiding clinical decision-making.