Autonomic Function and Exercise in Type 2 Diabetics

描述（由申请人提供）：糖尿病自主神经病变在2型糖尿病患者中发病率很高。更具体地说，心脏自主神经病变（CAN）是最常见的神经病变，在肥胖和2型糖尿病患者中与缺血性心脏病的增加、心律失常和猝死的发生率较高有关。近一半的糖尿病患者患有CAN，如果他们患有CAN，那么5年的死亡率就会大大增加。肥胖本身损害自主神经功能，但在2型糖尿病患者中，高胰岛素水平的环境也被推测进一步改变自主神经功能，可能导致该人群心律失常和猝死的发生率更高。运动和减肥已被证明可以改善肥胖个体的CAN，但在2型糖尿病个体中CAN的可逆性尚不清楚。本研究的目的是确定肥胖的非糖尿病患者和肥胖的2型糖尿病患者之间CAN是否存在差异，以及这种反应是否可以通过16周的有氧运动训练来改变。此外，我们还将确定这种对训练的反应是否存在性别差异。我们将招募40名男性和女性（40-60岁）（20名肥胖/非糖尿病患者和20名肥胖/ 2型糖尿病患者）。受试者将以65% V02最大值每周训练4天。这项研究将在有监督的环境中对受试者进行第一个月的培训，然后受试者将在有监督的家庭项目中进行培训。研究对象将在家中通过电话、电子邮件和网站来跟踪他们的进展。在研究开始和结束时，将测量受试者的代谢状态（葡萄糖和胰岛素水平（OGTT）、血脂、HbA 1c）和自主神经功能（心率变异性- hrv）。这个项目是第一个确定2型糖尿病患者在参加运动项目后自主神经功能是否能得到改善的项目之一，这是目前治疗的一部分。由于这一人群的死亡率增加，该项目将深入了解自主神经功能障碍是否可以逆转，以及这种反应是否存在性别差异。

DESCRIPTION (provided by applicant): Diabetic autonomic neuropathy is found with a high incidence in individuals with type 2 diabetes. More specifically, cardiac autonomic neuropathy (CAN) is the most common neuropathy found and is associated with an increase in ischemic heart disease and a higher incidence of arrhythmias and sudden death in obese and type 2 diabetic individuals. Nearly half of diabetic patients have CAN and if they do then the 5-yr mortality is substantially increased. Obesity alone compromises autonomic function, but in type 2 diabetics the hyperinsulinemic milieu is also speculated to further alter autonomic function potentially leading to the higher incidence of arrhythmias and sudden death in this population. Exercise and weight loss has been shown to improve CAN in obese individuals, but the reversibility of CAN in the type 2 diabetic individual is unclear. The purpose of this study is to determine if differences exist in CAN between obese non-diabetics and obese type 2 diabetic individuals, and if this response can be altered by 16 wk of aerobic exercise training. In addition we will also establish if gender differences occur with this response to training. We will recruit 40 men and women (40-60 yr) (20 obese/non-diabetics and 20 obese/ type 2 diabetics). Subjects will exercise train 4 days/wk at 65% V02 max. This study will train subjects in a supervised setting for the first month and then subjects will train in a supervised home-based program. Subjects will be monitored at home via phone, email and a website to track their progress. At the initiation and completion of the study, subjects will have their metabolic status (glucose and insulin levels (OGTT), blood lipids, HbA 1c) and autonomic function (heart rate variability-HRV) measured. This project is one of the first to determine if autonomic function can be improved in type 2 diabetics after participating in an exercise program, which is part of the current therapy. Because of the increased mortality in this population, this project will provide insight into whether autonomic dysfunction can be reversed and if gender differences occur in this response.