EXERCISE CAPACITY IN PEDIATRIC OBESITY AND TYPE 2 DIABETES

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 2型糖尿病（T2 DM）在美国成人和青少年人群中的流行比例正在增加。运动对预防和治疗T2 DM都至关重要。然而，成年T2 DM患者的运动能力较差，表现为最大和次最大运动能力降低。即使将T2 DM成人患者与同样久坐和同样肥胖的对照组进行比较，这一发现也是正确的。因此，有一些关于糖尿病，除了失调和肥胖，这使得这些人更难锻炼。这种运动缺陷可以通过异常内皮功能、异常舒张心脏功能、骨骼肌中的脂质沉积、炎症和/或胰岛素抵抗本身来解释。目前还没有研究2型糖尿病青少年是否已经有运动能力受损，也没有研究评估对运动功能至关重要的成分（内皮功能，舒张心功能，骨骼肌脂质含量或胰岛素抵抗本身的影响）的异常。然而，我们的初步研究表明，青少年糖尿病患者的运动功能降低。因此，本研究的目的是首先评估运动功能，通过Vo 2 max和Vo 2动力学测量，同时在自行车测力计上运动，在青少年2型糖尿病。这些受试者将与类似的活动瘦和肥胖对照组进行比较，以独立检查肥胖和不活动的影响。此外，次要结局将包括测量胰岛素敏感性（通过高胰岛素血症正葡萄糖钳夹）、内皮功能（通过肱动脉超声和体积描记术）、舒张功能（通过运动超声心动图）和自感劳累（通过博格量表）。此外，结局将与身体组成（腰围：臀围和双能X线吸收测定法）、炎症指标（C肽、C反应蛋白、IL-6和髓过氧化物酶）、肝脏炎症指标（丙氨酸氨基转移酶）、血脂（游离脂肪酸和空腹血脂谱）和脂联素相关。通过定义T2 DM青少年中存在的运动缺陷，并检查潜在的原因，我们希望改善儿童糖尿病的运动治疗方法，并帮助预防运动缺陷的发生或进展。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Type 2 diabetes (T2DM) is increasing in epidemic proportions among both adult and adolescent populations in the United States. Exercise is critical to both the prevention and treatment of T2DM. However, adults with T2DM are less able to exercise, as measured by reduced maximal and submaximal exercise performance. This finding holds true, even when adults with T2DM are compared to equally sedentary and equally obese controls. Therefore, there is something about the diabetes, beyond deconditioning and obesity, that makes it more difficult for such people to exercise. This exercise defect may be explainable by abnormal endothelial function, abnormal diastolic heart function, lipid deposition in skeletal muscle, inflammation, and/or the insulin resistance itself. There are currently no studies looking at whether adolescents with type 2 diabetes already have impairment in their ability to exercise, nor are there studies assessing abnormalities in components critical to exercise function (endothelial function, diastolic heart function, skeletal muscle lipid content, or the effects of insulin resistance itself). Our preliminary study indicates, however, that exercise function is reduced in adolescents with diabetes. Therefore, the goal of this study is to first assess exercise function, as measured by Vo2 max and Vo2 kinetics while exercising on a bicycle ergometer, in adolescents with type 2 diabetes. These subjects will be compared to similarly active lean and obese controls, to independently examine the effects of obesity and inactivity. In addition, secondary outcomes will include measurement of insulin sensitivity (by hyperinsulinemic euglycemic clamp), endothelial function (by brachial artery ultrasound and plethesmography), diastolic function (by echocardiogram with exercise), and perceived exertion (by Borg Scale). In addition, outcomes will be correlated with body composition (waist:hip circumference and dual energy x-ray absorptiometry), measures of inflammation (c-peptide, c-reactive protein, IL-6, and myeloperoxidase), measures of liver inflammation (alanine amino transferase), serum lipids (free fatty acids, and fasting lipid profile) and adiponectin. By defining the exercise defects present in adolescents with T2DM, and examining potential causes, we hope to improve the exercise treatment approach to pediatric diabetes and help prevent exercise defects from occurring or progressing.