A Cross-Sectional Study to Assess Cardiac Structure and Diastolic Function in Young Adults with Type 2 Diabetes Mellitus

Cilia M et al | DOI: 10.65188/nurexus.1084

Page 23

Journal of MedVerse Research & Practice

ISSN: 3107-4278

A Cross-Sectional Study to Assess Cardiac Structure and Diastolic

Function in Young Adults with Type 2 Diabetes Mellitus

M Cilia

1

, Merlin Andrea

2

Associate Professor, Professor

Department of Community Medicine

The Chinese University of Hong Kong Faculty of Medicine, China.

E-mail: Ciliam14456@gmail.com

Submission Date: 11.04.2026

Accepted Date: 21.05.2026

Published Date: 31.05.2026

DOI: 10.65188/nurexus.1084

article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted

use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Abstract

Background: Type 2 Diabetes Mellitus (T2DM) is increasingly recognized as a disease of young adults; however,

early cardiovascular sequelae including diabetic cardiomyopathy and left ventricular diastolic dysfunction may be

developing earlier still. Identifying these early signs of cardiac dysfunction are a key to preventing overt heart failure.

Materials and Methods: It was a cross-sectional study conducted in the Department of Cardiology at Chinese

University of Hong Kong Faculty of Medicine, china during 12 months. Methods: All 150 young adults (<40 years)

with T2DM were subjected to extensive clinical work-up, metabolic parameters and two-dimensional

echocardiography in this cross-sectional study. Echocardiographic measures including left ventricular mass, E/A

ratio and E/e′ ratio and ejection fraction were conducted. Statistical analyses were performed using SPSS and a P

<0.05 was considered statistically significant.

Results: The mean age was 34.8 ± 4.2 years with male predominance (58.7%). Left ventricular diastolic dysfunction

was observed in 45.3% of the patients, predominantly Grade I. Mean E/a ratio 1.02 ± 0.28 and mean E/e′ ratio, an

index of LV diastolic function was11.2 ± 2.6 suggesting impaired diastolic relaxation Detraining analysis and

myostatin level. Diastolic dysfunction was significantly associated with glycemic control (p < 0.001) and duration of

diabetes (p = 0.002). In most patients, the left ventricular systolic function was preserved.

Conclusion: Subclinical left ventricular diastolic dysfunction is very common in young adults with T2DM. This puts

patients in the window for therapy delivery when they undergo an early echocardiographic screening and have

optimal glycemic control, ideally utilizing other adjuncts to reduce cardiovascular event risk.

Keywords: Type 2 Diabetes Mellitus; Diastolic Dysfunction; Echocardiography; Diabetic Cardiomyopathy; Young

Adults; Left Ventricular Dysfunction.

Introduction

Type 2 Diabetes Mellitus (T2DM) is a common metabolic disorder and has become one of the biggest

public health problems in all societies [1]. The lifetime incidence of Type 2 Diabetes Mellitus (T2DM)

among young adults has more than doubled in recent decades due, at least in part, to rising rates of

overweight and obesity compounded by a declining level of physical activity, poor eating habits and

urbanisation. Due to long-term exposure to hyperglycemia and metabolic derangements, youth with T2DM

are at increased risk for early development of cardiovascular complications. [1,2]

Despite this development, cardiovascular disease continues to be the leading cause of morbidity and

ORIGINAL ARTICLE

Cilia M et al | DOI: 10.65188/nurexus.1084

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mortality among individuals with diabetes mellitus. In addition to accelerated atherosclerosis and coronary

artery disease, diabetes can also have direct effects on myocardial structure and function, causing diabetic

cardiomyopathy. [3] In the absence of hypertension, valvular heart disease, or ischemic heart disease we

identified and defined diabetic cardiomyopathy as cortical ventricular dysfunction. Background: Left

ventricular (LV) diastolic dysfunction has long been recognized as one of the earliest findings of diabetic

cardiomyopathy and may antedate the development of overt heart failure. [4] Type 2 Diabetes Mellitus

(DM2 P) has been recognized as a higher risk for Heart failure with preserved ejection fraction (HFpEF),

in which left ventricular diastolic dysfunction appears to play a central role in its pathogenesis. [5] Diastolic

dysfunction in early stages are usually asymptomatic and remains undiagnosed unless actively searched

for. In diabetic patients with asymptomatic cardiac involvement, recognition of subclinical abnormalities

is desirable because early intervention and strict glycemic control as well as adequate management of

cardiovascular risk factors may help to prevent progression to manifest cardiac disease. [6]

Echocardiography is a practical, non-invasive and reproducible imaging modality that can be applied to

assess cardiac geometry and ventricular function. This is important because: 1) it detects left ventricular

geometry and diastolic function abnormalities earlier in the setting of diabetic patients. Studies have shown

that patients with Type 2 Diabetes Mellitus start to gain mass of the left ventricle, subsequently develop

left ventricular geometry dysfunction at a much earlier and greater level than previously appreciated, which

can also be connected to diastolic function impairment [7]. Additionally, recent data indicate that younger

patients with T2DM experience stage-specific myocardial dysfunctions in the absence of overt clinical

and/or imaging-evident complications. [8,9] [10]

This cohort is at significant risk, including young adults with T2DM, as the early manifestation of

cardiovascular alterations frequently occurs during early stages of disease. However, there is a paucity of

data regarding echocardiographic evaluation of cardiac structure and diastolic dysfunction specifically in

Indian young adults with Type 2 Diabetes mellitus. Thus, the current study was carried out to evaluate

cardiac structure and diastolic function by echocardiography in non-asymptomatic adolescents/young

adults with Type 2 Diabetes Mellitus and their relation to clinical and metabolic variables.

Materials & Methods

Study Design and Setting

This hospital-based cross-sectional observational study was conducted in the Department of Cardiology at

Chinese University of Hong Kong Faculty of Medicine, China over a period of 12 months. The study was

undertaken to evaluate cardiac structural changes and left ventricular diastolic function among young adults

with Type 2 Diabetes Mellitus (T2DM). Participants were recruited consecutively from the outpatient and

inpatient services of the Departments of Cardiology and General Medicine. A total of 150 eligible patients

with T2DM were enrolled after obtaining written informed consent.

Study Population

The study population comprised young adults diagnosed with Type 2 Diabetes Mellitus attending the

Departments of Cardiology and General Medicine during the study period. All eligible participants

underwent clinical evaluation, laboratory investigations, and echocardiographic assessment according to

the study protocol.

Inclusion Criteria

Patients with a confirmed diagnosis of Type 2 Diabetes Mellitus who were younger than 40 years of age

were considered eligible for inclusion in the study. Both male and female patients were included. Only

those who were willing to participate and provided written informed consent after receiving a detailed

explanation of the study were enrolled.

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Exclusion Criteria

Patients diagnosed with Type 1 Diabetes Mellitus were excluded from the study. Individuals with a previous

history of ischemic heart disease, valvular heart disease, congenital heart disease, or cardiomyopathy due

to causes other than diabetes were also excluded to avoid confounding cardiac abnormalities. Patients with

chronic kidney disease, chronic liver disease, or pregnancy were not included because these conditions

could independently influence cardiac structure and function. In addition, patients who declined

participation or were unwilling to provide written informed consent were excluded from the study.

Data Collection

Following enrolment, each participant underwent a comprehensive clinical evaluation. Detailed

demographic characteristics and medical history were obtained using a structured case record form.

Information regarding the duration of diabetes, treatment history, smoking status, alcohol consumption,

associated comorbidities, and relevant family history was documented. A complete general physical

examination and systemic examination were performed for all participants.

Anthropometric measurements were obtained using standardized techniques. Height and weight were

measured with participants wearing light clothing and no footwear, and body mass index (BMI) was

calculated as weight in kilograms divided by the square of height in meters (kg/m²). Blood pressure was

measured using a calibrated sphygmomanometer after the participant had rested in the seated position for

at least five minutes. Two measurements were recorded, and the average value was used for analysis.

Laboratory Investigations

Venous blood samples were collected from all participants after an overnight fast. Fasting blood glucose,

postprandial blood glucose, and glycated hemoglobin (HbA1c) levels were estimated using standard

laboratory methods to assess glycemic status and long-term glycemic control. A complete lipid profile,

including total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein

cholesterol, was performed using automated biochemical analyzers. Renal function was evaluated by

measuring serum urea and creatinine levels to identify underlying renal impairment.

Echocardiographic Assessment

All participants underwent comprehensive two-dimensional transthoracic echocardiography using a

standard echocardiographic machine in the Department of Cardiology. Echocardiographic examinations

were performed by experienced cardiologists according to the recommendations of the American Society

of Echocardiography. Cardiac structural assessment included measurement of left ventricular mass, left

ventricular wall thickness, and left atrial dimensions.

Left ventricular diastolic function was evaluated using conventional pulsed-wave Doppler and tissue

Doppler imaging techniques. Mitral inflow early (E) and late (A) diastolic velocities were recorded, and

the E/A ratio was calculated. Tissue Doppler imaging was used to measure the early diastolic mitral annular

velocity (e′), from which the E/e′ ratio was derived to estimate left ventricular filling pressure. Based on

these echocardiographic findings, left ventricular diastolic dysfunction was graded according to

internationally accepted echocardiographic guidelines.

Statistical Analysis

The collected data were entered into Microsoft Excel and analyzed using the Statistical Package for the

Social Sciences (SPSS) software version 26.0 (IBM Corp., Armonk, NY, USA). Continuous variables were

expressed as mean ± standard deviation, whereas categorical variables were presented as frequencies and

percentages. Comparisons between study variables were performed using the Student's t-test for continuous

variables and the Chi-square test for categorical variables, as appropriate. A two-tailed p-value of less than

0.05 was considered statistically significant.

Ethical Considerations

The study protocol was approved by the Institutional Ethics Committee before the conducting of the study.

The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Written

informed consent was obtained from all participants before enrolment after explaining the purpose and

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procedures of the study. Participant confidentiality and anonymity were maintained throughout the study,

and all collected information was used exclusively for research purposes.

Results

Table 1. Demographic Characteristics of Study Participants (n = 150)

Variable

Mean ± SD / n (%)

Age (years)

34.8 ± 4.2

Male

88 (58.7%)

Female

62 (41.3%)

Duration of Diabetes (years)

6.4 ± 3.1

BMI (kg/m²)

28.6 ± 4.5

Smokers

36 (24.0%)

Hypertension

54 (36.0%)

The mean age of the study population was 34.8 ± 4.2 years, with a predominance of male participants

(58.7%). The mean duration of diabetes was 6.4 ± 3.1 years. Most participants were overweight with a

mean BMI of 28.6 ± 4.5 kg/m². Hypertension was present in 36% of patients, indicating coexistence of

cardiovascular risk factors among young adults with Type 2 Diabetes Mellitus.

Table 2. Clinical and Biochemical Parameters of Study Participants

Parameter

Mean ± SD

Fasting Blood Sugar (mg/dL)

168.4 ± 42.5

Postprandial Blood Sugar (mg/dL)

248.7 ± 58.3

HbA1c (%)

8.6 ± 1.4

Total Cholesterol (mg/dL)

204.3 ± 38.6

LDL Cholesterol (mg/dL)

126.5 ± 31.2

HDL Cholesterol (mg/dL)

41.8 ± 8.4

Triglycerides (mg/dL)

186.2 ± 46.7

Systolic BP (mmHg)

132.4 ± 14.5

Diastolic BP (mmHg)

84.6 ± 9.8

The study participants demonstrated poor glycemic control with a mean HbA1c of 8.6 ± 1.4%.

Dyslipidemia was also observed, with elevated total cholesterol, LDL cholesterol, and triglyceride levels.

Blood pressure values were higher than normal in a considerable proportion of participants, suggesting

increased cardiovascular risk in young adults with Type 2 Diabetes Mellitus.

Table 3. Echocardiographic Parameters of Study Participants

Echocardiographic Parameter

Mean ± SD

Left Ventricular Mass (g)

172.5 ± 28.4

Left Atrial Diameter (mm)

36.8 ± 4.2

Interventricular Septal Thickness (mm)

10.4 ± 1.3

Posterior Wall Thickness (mm)

10.1 ± 1.2

Ejection Fraction (%)

58.6 ± 5.4

E Wave Velocity (cm/s)

72.5 ± 12.8

A Wave Velocity (cm/s)

68.4 ± 10.6

E/A Ratio

1.02 ± 0.28

E/e’ Ratio

11.2 ± 2.6

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Echocardiographic assessment showed increased left ventricular mass and mild alterations in ventricular

wall thickness among study participants. The mean E/A ratio was reduced and the E/e’ ratio was elevated,

indicating the presence of impaired left ventricular relaxation and early diastolic dysfunction. However,

systolic function as assessed by ejection fraction was relatively preserved.

Table 4. Prevalence of Left Ventricular Diastolic Dysfunction

Diastolic Function Status

Number (%)

Normal Diastolic Function

82 (54.7%)

Grade I Diastolic Dysfunction

48 (32.0%)

Grade II Diastolic Dysfunction

16 (10.7%)

Grade III Diastolic Dysfunction

4 (2.6%)

Among the 150 study participants, 45.3% had evidence of left ventricular diastolic dysfunction. Grade I

diastolic dysfunction was the most common abnormality observed. Only a small proportion of participants

had advanced grades of dysfunction, suggesting that subclinical cardiac involvement occurs early in young

adults with Type 2 Diabetes Mellitus.

Table 5. Association Between HbA1c and Diastolic Dysfunction

HbA1c (%)

Normal Diastolic Function

Diastolic Dysfunction

p-value

<7%

32

10

<0.001

7–9%

38

34

>9%

12

24

A statistically significant association was observed between HbA1c levels and diastolic dysfunction (p

<0.001). Patients with poor glycemic control (HbA1c >9%) had a higher prevalence of diastolic dysfunction

compared to those with better glycemic control, indicating that persistent hyperglycemia may contribute to

early myocardial dysfunction.

Table 6. Association of Duration of Diabetes with Diastolic Dysfunction

Duration of Diabetes

Normal Diastolic Function

Diastolic Dysfunction

p-value

<5 years

40

18

0.002

5–10 years

30

28

>10 years

12

22

The prevalence of diastolic dysfunction increased significantly with longer duration of diabetes (p = 0.002).

Participants with diabetes duration greater than 10 years had a markedly higher frequency of diastolic

dysfunction compared to those with shorter disease duration, suggesting cumulative adverse effects of

diabetes on cardiac function over time.

Discussion

The present study evaluated cardiac structure and left ventricular diastolic function in young adults with

Type 2 Diabetes Mellitus (T2DM) using echocardiography. A high prevalence of subclinical left ventricular

diastolic dysfunction (45.3%) was observed despite preserved systolic function, indicating that diabetic

cardiomyopathy develops early and often remains clinically silent before progressing to overt heart failure.

The mean age of participants was 34.8 ± 4.2 years, highlighting that cardiovascular abnormalities can occur

even in younger adults with T2DM. This finding is consistent with the observations of Lascar et al., who

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reported an increasing burden of early cardiovascular complications among young diabetic individuals.[11]

Grade I diastolic dysfunction was the most frequent abnormality (32%), followed by Grade II dysfunction

(10.7%). Similar prevalence has been reported by Hariprasad et al. (42%) and Rehman et al. (approximately

40%) among asymptomatic T2DM patients.[12,13] The slightly higher prevalence in the present study may

be related to poorer glycemic control and longer disease duration.

Echocardiography demonstrated a reduced mean E/A ratio (1.02 ± 0.28) and elevated E/e′ ratio (11.2 ±

2.6), indicating impaired ventricular relaxation and increased filling pressures. Comparable findings were

reported by Tadic et al., who showed significantly impaired diastolic parameters among diabetic

patients.[14] In contrast, left ventricular ejection fraction remained preserved (58.6 ± 5.4%), supporting

previous evidence by Jiang et al. that diastolic dysfunction precedes systolic impairment in diabetic

cardiomyopathy.[15] Poor glycemic control showed a significant association with diastolic dysfunction (p

<0.001), with patients having HbA1c >9% demonstrating a markedly higher prevalence of dysfunction.

Similar findings have been reported by Hariprasad et al.[12] Chronic hyperglycemia contributes to

myocardial fibrosis, oxidative stress, and accumulation of advanced glycation end products, leading to

impaired myocardial relaxation.[16]

Duration of diabetes was also significantly associated with diastolic dysfunction (p = 0.002), with greater

prevalence among patients with disease duration exceeding 10 years. These findings agree with the

systematic review by Palanisamy et al., which demonstrated progressive worsening of diastolic function

with increasing duration of diabetes.[17] Additionally, obesity, hypertension, and dyslipidemia were more

common among affected individuals, consistent with the observations of Ceriello et al., who identified these

factors as important contributors to diabetic cardiomyopathy.[18] Recent evidence by Swiatkiewicz et al.,

Chen D et al and other contemporary reviews similarly indicates that approximately one-third to over 40%

of patients with T2DM exhibit asymptomatic left ventricular diastolic dysfunction, reinforcing the findings

of the present study and the need for early cardiovascular screening.[19,20]

The study is limited by its cross-sectional design, single-center setting, and relatively small sample size,

limiting causal inference and generalizability. Nevertheless, the findings emphasize the value of routine

echocardiographic assessment in young adults with T2DM for early detection of subclinical cardiac

dysfunction. Early optimization of glycemic control and management of associated cardiovascular risk

factors may delay progression to overt heart failure and improve long-term cardiovascular outcomes.

Strengths

The present study focused exclusively on young adults with Type 2 Diabetes Mellitus, a population in

whom diabetic cardiomyopathy is often under-recognized. Comprehensive echocardiographic evaluation

using conventional Doppler and tissue Doppler imaging enabled early detection of subclinical left

ventricular diastolic dysfunction before the onset of overt cardiovascular disease. The use of standardized

clinical, laboratory, and echocardiographic assessment protocols enhanced the reliability and consistency

of the study findings.

Limitations

This study has several limitations. First, its cross-sectional design precludes the establishment of a causal

relationship between Type 2 Diabetes Mellitus and cardiac structural or diastolic abnormalities. Second,

the study was conducted at a single tertiary care center with a relatively modest sample size, which may

limit the generalizability of the findings to the broader population. Third, the absence of a non-diabetic

control group restricted direct comparison of echocardiographic parameters between diabetic and healthy

individuals. Finally, longitudinal follow-up was not performed; therefore, the progression of diastolic

dysfunction and its clinical outcomes could not be evaluated.

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Conclusion

The current study proved reduced left ventricular diastolic dysfunction in young adults with Type 2

Diabetes Mellitus despite a preserved systolic function, suggesting that cardiac remodeling of some degree

is present even in the early phases of the disease. Echocardiographic findings were independently associated

with poor glycemic control, diabetes duration, obesity, hypertension and dyslipidemia. Even adolescents

who have asymptomatic type 1 diabetes are beginning to develop diabetic cardiomyopathy, indicating that

the process begins early in the course of disease. Thus, echo screening nowadays and treat the HGL

aggressively plus cardiovascular NiRF is wise early approach to preventing overt heart failure in T2DM

even when asymptomatic.

Conflict of Interest

The authors declare that there is no conflict of interest regarding the publication of this study.

Source of Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-

for-profit sectors. The study was self-funded by the authors.

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