In France, nearly 4 million people take medication for their diabetes. In recent decades, the number of diabetics has doubled worldwide with nearly 8.5% of the world’s population affected. Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin or when the body is unable to use the insulin it produces effectively. This results in an increased concentration of glucose in the blood (hyperglycemia).

Type 2 diabetes develops silently and can be diagnosed when an acute episode appears requiring medical care of the patient. Unfortunately in this case diabetes has already damaged the organs. This disease represents an increased risk of cardiovascular accidents, heart failure, and is the cause of renal failure and peripheral neuropathy.

The IHU ICAN teams are particularly mobilized to better understand the pathological mechanisms associated with diabetes in order to develop new therapies and improve patient care.

Heart failure (HF) in patients with type 2 diabetes (T2D) represents a complex and heterogeneous clinical syndrome. HF in patients with T2DM is associated with a significant risk of death, recurrent hospitalizations and deterioration in quality of life.

It is therefore essential to recognize patients with T2D and undiagnosed myocardial dysfunction who are at high risk for acute HF decompensation.

The reduction in glucose levels in type 2 diabetes leads to major metabolic changes and requires metabolic adaptation of the tissues. It is not known how cardiac metabolism can be acutely affected by changes in blood sugar.

To date, the consequences of the short-term reduction in glucose levels in the heart are not known. There is no previous publication with a similar protocol for the heart. It is therefore essential that the disciplines talk to each other in order to provide comprehensive and personalized care to patients.

The objective of our research is to demonstrate that cardiac metabolic inflexibility is present in some patients with chronic hyperglycemia and revealed during the treatment of their diabetes by insulin therapy.

Defects in metabolic flexibility will be evidenced by changes in cardiac segmental contractility on MRI and by extracellular expansion. This study uses state-of-the-art imaging, which is possible at the IHU ICAN thanks to the recent acquisition of a latest-generation 1.5T cardiovascular MRI specifically dedicated to cardiovascular and metabolic research on humans.

The IHU ICAN is very involved in setting up this project and in its execution, in particular with the participation of several of these platforms:

• ICAN BioCollection for the storage of samples and their preparations
• ICAN Imaging for MRI image acquisition and CoreLab imaging for reading and interpreting MRI images
• ICAN Omics for the assay and interpretation of relevant biomarkers

This study will therefore:

• Identify biomarkers for early detection of metabolic heart failure associated with type 2 diabetes
• Improving the prediction of the evolution of type 2 diabetes thanks to imaging

Project leader:

Pr Fabrizio Andreelli, diabetologist AP-HP, Pitié -Salpêtrière, IHU ICAN

Scientific team

• Pr Richard Isnard, cardiologist, Pitié Salpêtrière Cardiology Institute, IHU ICAN,
• Pr Alban Redheuil, medical manager of the Imaging IHU ICAN platform, head of the Cardiovascular and Thoracic Imaging (ICT) unit, Pitié Salpêtrière,
• Nadjia Kachenoura, scientific manager of the Imaging IHU ICAN platform, head of the cardiovascular imaging team of the Biomedical Imaging Laboratory, (LIB, Sorbonne University)