Cardiac remodeling is frequently observed in individuals with type 2 diabetes mellitus (T2DM), but the relationship between glycemic improvement and myocardial lipid accumulation remains unclear. An uncontrolled exploratory longitudinal study published in Cardiovascular Diabetology evaluated changes in myocardial triglyceride content (MTGC) and cardiac remodeling after glycemic optimization in adults with newly diagnosed T2DM.
Twenty adults with newly diagnosed T2DM underwent a 12-month standardized glycemic optimization protocol that included insulin, metformin, and empagliflozin, along with nutritional and lifestyle counseling. Cardiac magnetic resonance imaging (CMR) and proton magnetic resonance spectroscopy (¹H-MRS) were performed at baseline and after 12 months to assess cardiac structure, ventricular function, and MTGC. Participants had a mean age of 54.8 ± 9 years and 72.3% were male.
Significant reductions occurred in glycated hemoglobin (HbA1c), body mass index (BMI), and waist circumference (WC). MTGC did not change significantly during follow-up (p = 0.23). CMR showed an increase in left ventricular ejection fraction from 59.0% (54.8-61.5) to 63.1% (56.9-66.3) (p = 0.01). Left ventricular end-systolic volume decreased from 29.9 to 27.3 mL/m² (p = 0.007). Right ventricular end-systolic volume decreased from 30.6 to 28.7 mL/m² (p = 0.02), and right ventricular end-diastolic volume declined from 76.5 to 72.4 mL/m² (p = 0.03). Indexed left ventricular mass increased from 46.1 to 49.5 g/m² (p = 0.006).
No associations were observed between HbA1c improvement and MTGC or CMR parameters. In contrast, reductions in BMI and WC correlated with greater left atrial strain (ρ = −0.78 and −0.77; p < 0.001). Reductions in WC also correlated with greater left ventricular end-diastolic volume (ρ = −0.59; p = 0.024). Cardiac remodeling changes occurred despite stable myocardial triglyceride content, and the observed changes were more closely related to reductions in adiposity markers than to improvements in HbA1c.
