Protecting the heart from damage caused by diabetes

Image of Dr Gaurav Gulsin

Dr Gaurav Gulsin is studying how type 2 diabetes affects the heart. He explains how his BHF-funded research could help prevent heart failure in people with diabetes. 

For reasons we don't completely understand, if you have type 2 diabetes you're more likely to develop heart failure in the long term. Previous research has shown that up to one third of people with type 2 diabetes who don’t have any symptoms of heart disease have early signs of damage to the heart, and it’s a real risk that those people will go on to develop heart failure. 

In the PREDICT study, we’re assessing 150 people with type 2 diabetes and 50 people without, to identify changes in the hearts of people with diabetes and see if we can detect early heart failure. 

By also studying 50 people without type 2 diabetes, we hope to identify differences between the hearts of people with and without diabetes.

Dr Gaurav Gulsin

At the outset, we do a thorough assessment of the participants’ heart health, using the latest technology available to study the heart. We look at their heart’s structure and function, and measure their blood sugar and cholesterol. We also monitor their blood pressure over 24 hours and their physical activity over a week. We’ll then use medical records to see which people develop heart problems over the next five years. 

By also studying 50 people without type 2 diabetes, we hope to identify differences between the hearts of people with and without diabetes.

We hope to find clues to identify people with diabetes who are more likely to develop heart failure. In the future, we could monitor these people more closely and help them to reduce their other risk factors, such as weight, blood pressure and cholesterol. 

Another trial that we have recently completed – called the DIASTOLIC study - assessed whether a low calorie diet or physical activity can help to reverse hidden damage to the heart in people with type 2 diabetes. We aim to share the results of this trial very soon. Our ultimate aim is to offer new treatments to protect people with diabetes from heart failure.  

Home blood sugar monitor and heart 

Diabetes drugs to protect the heart?  

A group of drugs called SGLT2 inhibitors (or gliflozins) have recently been developed to help control type 2 diabetes. They do this by reducing the amount of sugar that’s absorbed back into the blood by the kidneys, so that more sugar is passed out in the urine instead. This reduces sugar levels in the blood.
 
Interestingly, there is some evidence that these drugs could also help to lower the risk of heart disease in people with diabetes. This could be down to the fact that SGLT2 inhibitors may also lower blood pressure.  
 
We’re also interested in another class of drugs, which are used to treat type 2 diabetes, called incretin mimetics (or GLP-1 analogues). These drugs work by mimicking hormones called incretins, which help to control blood sugar levels by stimulating the pancreas to produce more insulin when it’s needed. They also reduce appetite, and can therefore help people to lose small amounts of weight. 
 
We’re interested in these drugs because trials have shown that they also reduce the risk of having a heart attack, which may be due to the weight loss or other unknown factors. 
 
For both SGLT2 inhibitors and incretin mimetics, we’re waiting for ongoing studies to tell us definitively whether these drugs can lower the risk of heart disease in people with diabetes. If they can, then we hope our research could help to identify the patients who could benefit most from taking them.  

 

Meet the expert

 
Dr Gaurav Gulsin is a trainee cardiologist and BHF Clinical Research Training Fellow at the University of Leicester. He is working on a BHF research project, led by Professor Gerry McCann, studying how type 2 diabetes affects the heart.  

 

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