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Ages Eligible for Study:
35 Years to 65 Years (Adult, Older Adult)
Sexes Eligible for Study:
Accepts Healthy Volunteers:
Patients with known T2DM and who are not taking exogenous insulin.
Subjects must be >30 and <65 years of age, in order to limit the confounding affect of age on our endpoints.
Subjects must have an ejection fraction >45% (based on their echocardiogram)
Patients with T2DM and nonalcoholic fatty liver disease or steatohepatitis may be included since they have extensive evidence of steatosis.
Subjects who have had a myocardial infarction or resting ischemia (by history or as evidenced by hypo/akinesis on the pre-intervention echocardiogram) will be excluded because hypo/akinesis would affect our endpoints of LV mass and diastolic function.
Subjects who are unstable, not able to lie flat for the imaging studies, unable to give informed consent, pregnant, lactating, with atrial fibrillation (which would compromise measurement of E'), or current smokers will be excluded.
Subjects with other major systemic diseases per their clinical charts, history, physical exam, or significant renal insufficiency will also be excluded, as these other system diseases may affect our study endpoints and subject follow-up.
We will exclude patients with significant LV systolic dysfunction (ejection fraction <45%)
We will not exclude patients with sleep apnea because it does not detrimentally affect LV diastolic function.
Subjects will be excluded a priori if they have any history or evidence of liver disease other than NAFLD, consumed >20 g alcohol per day.