Prevalence, predictors and evolution of echocardiographically defined cardiac abnormalities in adults with type 1 diabetes: an observational cohort study

J Diabetes Complications. 2014 Jan-Feb;28(1):22-8. doi: 10.1016/j.jdiacomp.2013.09.013. Epub 2013 Oct 7.


Aims/hypothesis: The aims of this observational study were to determine the prevalence and predictors of an abnormal echocardiogram in adults with type 1 diabetes, and to assess the evolution of changes in a subset of subjects.

Methods: Cardiac function and structure were prospectively investigated by comprehensive transthoracic echocardiographic techniques in asymptomatic adults with type 1 diabetes seen in the ambulatory care setting.

Results: We recruited 136 subjects (mean age 39 years, SD 14 years) with a median diabetes duration of 21 years [25(th), 75(th) interquartile range; 11, 29]. An abnormal echocardiogram was present in 29% of subjects; diastolic dysfunction in 69%, left ventricular hypertrophy in 38% and systolic dysfunction in 10%. The independent predictors of an abnormal echocardiogram were age, with a 9-fold increase in those ≥40 years (OR 9.40 [95% CI 2.68-33.04], P <0.0001), and increased body mass index (BMI), with a 17% increase in risk (P=0.04). A second echocardiogram was available in 65 subjects (3.8±1.7 years later). The results showed that one in five with a normal first study had developed an abnormal second study, mainly diastolic dysfunction, with age being the only independent predictor of progression (P=0.006).

Conclusions/interpretation: Subclinical echocardiographic abnormalities are common in asymptomatic type 1 diabetes adults, and changes are progressive. The addition of an echocardiogram to complication surveillance programs in those with type 1 diabetes aged ≥40 years may represent a cost-effective way to screen for, and aggressively treat, occult cardiac disease.

Keywords: Cardiac disease; Diastolic dysfunction; Echocardiography; Left ventricular hypertrophy; Type 1 diabetes mellitus.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cohort Studies
  • Diabetes Mellitus, Type 1 / complications*
  • Diabetes Mellitus, Type 1 / diagnostic imaging*
  • Diabetes Mellitus, Type 1 / epidemiology*
  • Diabetic Cardiomyopathies / diagnostic imaging
  • Diabetic Cardiomyopathies / epidemiology
  • Diabetic Cardiomyopathies / etiology
  • Disease Progression
  • Echocardiography / statistics & numerical data
  • Female
  • Heart Diseases / diagnostic imaging*
  • Heart Diseases / epidemiology*
  • Heart Diseases / etiology*
  • Humans
  • Hypertrophy, Left Ventricular / diagnostic imaging
  • Hypertrophy, Left Ventricular / epidemiology
  • Hypertrophy, Left Ventricular / etiology
  • Male
  • Middle Aged
  • Prevalence
  • Prognosis
  • Risk Factors
  • Ventricular Dysfunction, Left / diagnostic imaging
  • Ventricular Dysfunction, Left / epidemiology
  • Ventricular Dysfunction, Left / etiology