CHAPTER 7 | STUDY 3: ADDING BEHAVIOURAL NORMS
7.1.2 DIFFERENT TYPES OF NORMS
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and AAs (aldosterone antagonists) have been demonstrated to delay the development and progression from preclinical geometry remodeling and diastolic dysfunction towards congestive cardiac failure (CCF)55,229.
Despite concern of the increased incidence of heart failure associated with the use of thiazolidinediones in the treatment of patients with T2DM, thiazolidinediones is still being used in the treatment of DM though cautiously. Naka et al230 in his work done on eighty-eight asymptomatic T2DM patients with LVDD, reported that the addition of pioglitazone to oral conventional treatment for 6 months does not induce any adverse or favourable changes in LV diastolic or systolic function despite improvements in glycaemic control, insulin sensitivity, lipid profile and blood pressure. This suggest that, its use is still probably important in primary prevention of diabetic cardiomyopathy in T2DM patients.
However, treatment of CCF from diabetic cardiomyopathy does not differ from cardiomyopathyof other aetiologies and therefore has to follow the appropriate guidelines.
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CHAPTER SEVEN
CONCLUSION
This cross-sectional study demonstrated the following:
The prevalence of microalbuminuria is significantly higher in normotenive type 2 diabetic patients compared to healthy controls.
The prevalence of abnormal geometry pattern and diastolic dysfunction are significantly higher in microalbuminuric group than normoalbuminuric group.
Although ejection fraction values in the three groups are comparable, there is significant decrease in fractional shortening in microalbuminuric compared to control and normoalbuminuric groups.
Microalbuminuria detected by the semiquantitative method has a strong direct association with left ventricular geometry remodeling and diastolic dysfunction in normotensive diabetics.
Aging is directly and independently associated with LV diastolic dysfunction among normotensive patients with T2DM.
Duration of DM is directly and independently associated with LV geometry remodeling in normotensive type 2 diabetics subjects.
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RECOMMENDATION
This study has thrown more light on the association of microalbuminuria with LV geometry remodeling and diastolic dysfunction in normotensive subjects with T2DM.
It is recommended that all patients with type 2 diabetes should be routinely and repeatedly screened for microalbuminuria and macroalbuminuria which are markers of endothelial dysfunction in them.
It is necessary to screen diabetics early for preclinical left ventricular remodeling and dysfunction which may be present even in patients with short duration of DM using 2D-guided M-mode and Doppler echocardiography.
Future studies should use the quantitative assessment for microalbuminuria.
LIMITATION OF STUDY
This was a cross-sectional study, thus cannot demonstrate causative correlation ofmicroalbuminuria with abnormal left ventricular geometry and function.
Microalbuminuria test was done by the semi-quantitative method using micral test strips, this may have overestimated the prevalence of microalbuminuria.
LINE OF FUTURE STUDY
A study with larger sample size with prospective (cohort) design is necessary in order to observe the causative correlation of microalbuminuria with left ventricular diastolic dysfunction as well as geometry remodelling.
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A prospective study to search for optimal therapy for prevention and treatment of this cardiomyopathy is worth a trial.
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