A low-carbohydrate diet in place of SGLT2i therapy in a patient with diabetic cardiomyopathy.

IF 0.7 Q4 ENDOCRINOLOGY & METABOLISM Endocrinology, Diabetes and Metabolism Case Reports Pub Date : 2023-12-13 Print Date: 2023-10-01 DOI:10.1530/EDM-23-0086
Sabine Kleissl-Muir, Bodil Rasmussen, Alice Owen, Caryn Zinn, Andrea Driscoll
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Abstract

Summary: In patients with diabetes mellitus, the toxic milieu caused by abnormal glucose and free fatty acid handling can lead to heart failure (HF). Referred to as diabetic cardiomyopathy (DMCM), this syndrome often exists in the absence of conventional risk factors for HF such as history of myocardial infarction or hypertension. Low-carbohydrate diets (LCDs) have recently been endorsed as an efficacious therapeutic dietary approach to prevent and reverse cardiometabolic disease including type 2 diabetes mellitus (T2DM). LCDs improve systemic insulin resistance (IR), reverses cardiac remodelling in a rodent model and downregulates the expression of sodium-glucose co-transporter 2 (SGLT2) receptors in the kidney. It is therefore conceivable that a lifestyle approach such as adopting an LCD can be offered to patients with DMCM. The reported case is that of a 45-year-old man with a 15-year history of non-ischaemic cardiomyopathy, T2DM and obesity. The patient volunteered to engage in a 16-week low-carbohydrate dietary intervention trial and then self-selected to remain on this diet for 1 year. The whole-food LCD was based on simple 'traffic light' style food lists and not designed to restrict calories, protein, fat or salt. After 1 year, the patient had lost 39 kg and his cardiometabolic markers had significantly improved. LCDs present a potentially beneficial approach for patients with DMCM and could be considered as a lifestyle intervention before SGLT2i therapy is commenced.

Learning points: Diabetic cardiomyopathy (DMCM) is a syndrome precipitated mainly by the detrimental effects of glucose metabolism disorders such as insulin resistance and diabetes. Low-carbohydrate diets (LCD) mimic many effects of sodium-glucose co-transporter 2 inhibitors (SGLT2i). LCDs are a dietary pattern which can have significant and beneficial effects on metabolic and anthropometric markers in patients with DMCM. LCDs and SGLT2i therapy could be combined and may achieve better clinical outcomes for patients with DMCM. Combination therapy may be carried out under close supervision as the real risk for diabetic ketoacidosis remains.

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糖尿病心肌病患者用低碳水化合物饮食代替 SGLT2i 治疗。
摘要:在糖尿病患者中,葡萄糖和游离脂肪酸处理异常引起的毒性环境可导致心力衰竭(HF)。这种综合征被称为糖尿病心肌病(DMCM),通常没有心肌梗死或高血压等心衰的传统危险因素。低碳水化合物饮食(LCD)最近被认为是预防和逆转包括 2 型糖尿病(T2DM)在内的心血管代谢疾病的有效饮食治疗方法。低碳水化合物饮食可改善全身胰岛素抵抗(IR),逆转啮齿动物模型的心脏重塑,并下调肾脏中钠-葡萄糖协同转运体 2(SGLT2)受体的表达。因此,可以设想为 DMCM 患者提供一种生活方式,如采用 LCD。报告中的病例是一名 45 岁的男性,有 15 年的非缺血性心肌病、T2DM 和肥胖病史。该患者自愿参加了为期 16 周的低碳水化合物饮食干预试验,然后自主选择在 1 年内保持这种饮食习惯。全食物液晶显示屏基于简单的 "红绿灯 "式食物清单,不限制热量、蛋白质、脂肪或盐。1 年后,患者体重减轻了 39 公斤,心脏代谢指标也明显改善。LCD为DMCM患者提供了一种潜在的有益方法,在开始SGLT2i治疗前,可考虑将其作为一种生活方式干预措施:糖尿病心肌病(DMCM)是一种主要由胰岛素抵抗和糖尿病等糖代谢紊乱的有害影响引起的综合征。低碳水化合物饮食(LCD)可模拟钠-葡萄糖协同转运体 2 抑制剂(SGLT2i)的多种作用。低碳水化合物饮食是一种饮食模式,对 DMCM 患者的代谢和人体测量指标有显著的有益影响。可将 LCDs 和 SGLT2i疗法结合起来,为 DMCM 患者带来更好的临床疗效。由于糖尿病酮症酸中毒的实际风险仍然存在,因此应在密切监督下进行联合治疗。
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来源期刊
CiteScore
1.50
自引率
0.00%
发文量
142
审稿时长
9 weeks
期刊介绍: Endocrinology, Diabetes & Metabolism Case Reports publishes case reports on common and rare conditions in all areas of clinical endocrinology, diabetes and metabolism. Articles should include clear learning points which readers can use to inform medical education or clinical practice. The types of cases of interest to Endocrinology, Diabetes & Metabolism Case Reports include: -Insight into disease pathogenesis or mechanism of therapy - Novel diagnostic procedure - Novel treatment - Unique/unexpected symptoms or presentations of a disease - New disease or syndrome: presentations/diagnosis/management - Unusual effects of medical treatment - Error in diagnosis/pitfalls and caveats
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