Autonomic Function and Exercise in Type 2 Diabetics

描述(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较高。更具体地说，心脏自主神经病变(CAN)是发现的最常见的神经病变，与肥胖和2型糖尿病患者中缺血性心脏病的增加以及心律失常和猝死的发生率更高有关。近一半的糖尿病患者有CAN，如果他们有，那么5年内的死亡率就会大幅增加。肥胖本身就会损害自主神经功能，但在2型糖尿病患者中，高胰岛素环境也可能进一步改变自主神经功能，可能导致该人群更高的心律失常和猝死发生率。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型糖尿病患者之间是否存在CAN的差异，以及这种反应是否可以通过16wk的有氧运动训练来改变。此外，我们还将确定在对培训的反应中是否会出现性别差异。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)。受试者每周锻炼4天，最大负荷为65%V02。这项研究将在第一个月的监督环境中对受试者进行培训，然后受试者将在受监督的家庭项目中进行培训。受试者将在家中通过电话、电子邮件和网站进行监控，以跟踪他们的进展。在研究开始和完成时，受试者将接受代谢状态(葡萄糖和胰岛素水平(OGTT)、血脂、HbA1c)和自主神经功能(心率变异性-HRV)的测量。该项目是第一个确定2型糖尿病患者在参加锻炼计划后自主神经功能是否可以改善的项目之一，锻炼计划是目前治疗的一部分。由于这一人群死亡率的增加，该项目将提供关于自主神经功能障碍是否可以逆转以及在这种反应中是否出现性别差异的洞察力。

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.