Strength Training Regimen fOr Normal weiGht Diabetics (STRONG-D)

描述（由申请人提供）：体重正常的2型糖尿病（NWD）患者的死亡率高于超重或肥胖患者。与脂肪组织相比，NWD的瘦肌肉量可能更少，这可能导致更高的死亡率。力量训练增加肌肉量而不是减轻体重，并且可以对抗与年龄相关的身体成分变化，这种变化导致脂肪量增加和肌肉量减少（即肌肉减少症）。因此，力量训练可能对NWD有帮助，而不是减轻体重，而对于超重/肥胖的2型糖尿病（T2DM）患者则是如此。此外，NWD的力量训练可以消除种族/民族之间内脏脂肪的已知差异。这可能对NWD的管理具有重要意义。目前，缺乏针对NWD的有效生活方式建议的数据，NWD可代表多达五分之一的2型糖尿病患者。体育活动建议强调有氧运动，这可能不适合NWD。体脂评估，而不是体重指数，可能是NWD更好的诊断工具，并更好地告知治疗性生活方式改变干预措施，以控制血糖，最终减轻显著较高的死亡率

DESCRIPTION (provided by applicant): Normal weight individuals with type 2 diabetes (NWD) have higher risk of mortality than overweight or obese individuals. NWD may have less lean muscle mass in proportion to adipose tissue, which may contribute to this higher risk of mortality. Strength training increases muscle mass rather than reducing body weight and can combat the age-related shift in body composition that results in higher fat mass and decreased muscle mass (i.e., sarcopenia). Thus, strength training may therefore be helpful for NWD rather than weight loss, as is recommended for overweight/obese individuals with type 2 diabetes (T2DM). Additionally, strength training in NWD could eliminate known differences in visceral adiposity across racial/ethnic groups. This may have significant implications for management of NWD. Currently, there is a lack of data on effective lifestyle recommendations for NWD, who can represent up to 1 in 5 individuals with T2DM. Physical activity recommendations emphasize aerobic exercise, which may not be appropriate for NWD. Body fat assessment, rather than body mass index, may be a better diagnostic tool in NWD, and better inform therapeutic lifestyle change interventions to control glucose and ultimately alleviate the significantly higher mortality discovered for this group. Strength training, rather than aerobic-focused regimens, may be a more appropriate treatment recommendation. In order to determine the best exercise regimen for NWD, we propose to implement a three- arm randomized control trial comparing the clinical effectiveness of strength training vs. aerobic training vs. combined (strength + aerobic) training for T2DM management among NWD at the Palo Alto Medical Foundation (PAMF), a large, community-based, multi-specialty ambulatory care setting. The primary outcome for measurement will be improvement in T2DM control (e.g., % hemoglobin A1c reduction). Process measures will include changes in physical fitness (e.g., VO2 max), and change in body composition (DEXA scans).While the benefits of combined (strength + aerobic) activity have been well demonstrated in overweight/obese diabetics, there currently exists little evidence to recommend this regimen in NWD. The goal of the Strength Training Regimen for Normal weiGht Diabetics (STRONG-D) Study is to determine the best exercise regimen for NWD, who experience greater mortality than overweight/obese diabetics.