Effects of Low-Energy Diet or Exercise on Cardiovascular Function in Working-Age Adults With Type 2 Diabetes: A Prospective, Randomized, Open-Label, Blinded End Point Trial
Effects of Low-Energy Diet or Exercise on Cardiovascular Function in Working-Age Adults With Type 2 Diabetes: A Prospective, Randomized, Open-Label, Blinded End Point Trial
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DOI：
10.2337/dc20-0129
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发表时间：
2020-06-01
期刊：
影响因子：
16.2
通讯作者：
McCann, Gerry P.
中科院分区：
文献类型：
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作者：
Gulsin, Gaurav S.;Swarbrick, Daniel J.;McCann, Gerry P.
目的 确认患有 2 型糖尿病 (T2D) 的工作年龄成人是否存在亚临床心血管功能障碍，并确定低能量代餐饮食 (MRP) 或运动训练是否可以改善这种情况。研究设计和方法 本文报告了一项前瞻性、随机、开放标签、盲法终点试验和巢式病例对照研究。无症状的 T2D 年轻成人按照 1:1:1 的比例随机接受为期 12 周的干预：1) 常规护理，2) 有监督的有氧运动训练，或 3) 低能量（类似于 810 kcal/天）MRP。参与者在基线和 12 周时接受了超声心动图、心肺运动测试和心脏磁共振 (CMR)。主要结果是通过 CMR 测量的左心室 (LV) 峰值早期舒张应变率 (PEDSR) 的变化。健康志愿者被纳入基线病例对照比较。结果 纳入 87 名 T2D 参与者（年龄 51 +/- 7 岁，HbA(1c) 7.3 +/- 1.1%）和 36 名匹配的对照参与者。在基线时，与对照参与者相比，T2D 患者有舒张功能障碍的证据（PEDSR 1.01 +/- 0.19 与 1.10 +/- 0.16 s(-1)，P = 0.02）。 76 名 T2D 参与者完成了试验（30 名常规护理、22 名运动和 24 名 MRP）。 MRP 臂减重 13 公斤，血压、血糖、左心室质量/体积和主动脉僵硬度得到改善。运动臂的体重减轻可以忽略不计，但运动能力有所提高。与常规护理相比，运动组的 PEDSR 有所增加（β = 0.132，P = 0.002），但 MRP 没有改善（β = 0.016，P = 0.731）。结论 对于患有 T2D 的无症状工作年龄成人，运动训练可改善舒张功能。尽管减肥对血糖控制、左心室同心重塑和主动脉僵化有有益影响，但低能量 MRP 并不能改善舒张功能。
OBJECTIVE To confirm the presence of subclinical cardiovascular dysfunction in working-age adults with type 2 diabetes (T2D) and determine whether this is improved by a low-energy meal replacement diet (MRP) or exercise training. RESEARCH DESIGN AND METHODS This article reports on a prospective, randomized, open-label, blinded end point trial with nested case-control study. Asymptomatic younger adults with T2D were randomized 1:1:1 to a 12-week intervention of 1) routine care, 2) supervised aerobic exercise training, or 3) a low-energy (similar to 810 kcal/day) MRP. Participants underwent echocardiography, cardiopulmonary exercise testing, and cardiac magnetic resonance (CMR) at baseline and 12 weeks. The primary outcome was change in left ventricular (LV) peak early diastolic strain rate (PEDSR) as measured by CMR. Healthy volunteers were enrolled for baseline case-control comparison. RESULTS Eighty-seven participants with T2D (age 51 +/- 7 years, HbA(1c) 7.3 +/- 1.1%) and 36 matched control participants were included. At baseline, those with T2D had evidence of diastolic dysfunction (PEDSR 1.01 +/- 0.19 vs. 1.10 +/- 0.16 s(-1), P = 0.02) compared with control participants. Seventy-six participants with T2D completed the trial (30 routine care, 22 exercise, and 24 MRP). The MRP arm lost 13 kg in weight and had improved blood pressure, glycemia, LV mass/volume, and aortic stiffness. The exercise arm had negligible weight loss but increased exercise capacity. PEDSR increased in the exercise arm versus routine care (beta = 0.132, P = 0.002) but did not improve with the MRP (beta = 0.016, P = 0.731). CONCLUSIONS In asymptomatic working-age adults with T2D, exercise training improved diastolic function. Despite beneficial effects of weight loss on glycemic control, concentric LV remodeling, and aortic stiffness, a low-energy MRP did not improve diastolic function.