The relationship between glycemic control and cardiac involvement may be particularly relevant in patients with coexisting T2DM and HF, where poorer glycemic control may reflect greater myocardial stress and dysfunction.

This hospital-based study included adults with established T2DM and HF who underwent HbA1c, NT-proBNP, and transthoracic echocardiography between March 2024 and July 2026. Participants were categorized by HbA1c (<7.0%, 7.0–7.9%, 8.0–8.9%, and ≥9.0%). Echocardiographic measures included left ventricular ejection fraction (LVEF), left ventricular mass index, left atrial volume index, E/e′ ratio, diastolic function, and tricuspid annular plane systolic excursion. Associations were assessed using correlation and multivariable regression.

Among 694 participants, mean age was 61.8 ± 10.7 years and 417 (60.1%) were men. Median HbA1c was 8.1% (IQR, 7.2–9.3%). Median NT-proBNP increased across HbA1c categories, from 1,032 pg/mL with HbA1c <7.0% to 2,021 pg/mL with HbA1c ≥9.0% (P for trend <0.001). HbA1c correlated with log-transformed NT-proBNP (Spearman ρ=0.29; P<0.001). After adjustment, each 1-percentage-point increase in HbA1c was associated with a 0.12-unit increase in log-transformed NT-proBNP (95% CI, 0.07–0.17; P<0.001), corresponding to approximately 13% higher NT-proBNP. Higher HbA1c was independently associated with lower LVEF (β=−0.74; P=0.001), higher E/e′ ratio (β=0.51; P<0.001), and greater left atrial volume index (β=0.62 mL/m²; P=0.005). Each 1-percentage-point increase in HbA1c was associated with higher odds of cardiac dysfunction (adjusted OR, 1.28; 95% CI, 1.14–1.44; P<0.001). Adding HbA1c and NT-proBNP increased AUC from 0.76 to 0.87.

In adults with T2DM and HF, poorer glycemic control was independently associated with higher NT-proBNP and greater echocardiographic cardiac dysfunction. Prospective studies are needed to establish prognostic and clinical implications.

Partha Sarathi Datta is a Public Health Research Lead at the Centre for Public Health and Hygiene Research (CPHHR), with over a decade of experience in research on cardiometabolic risk factors and related public health outcomes. He has authored/co-authored 25+ peer-reviewed journal publications and has contributed to numerous national and international scientific conferences through oral and poster presentations. His research interests include cardiometabolic health, diabetes, cardiovascular diseases, and population-based risk assessment.