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Original Research
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
Gaurav S. Gulsin, Daniel J. Swarbrick, Lavanya Athithan, Emer M. Brady, Joseph Henson, Emma Baldry, Stavroula Argyridou, Nishal B. Jaicim, Gareth Squire, Yvette Walters, Anna-Marie Marsh, John McAdam, Kelly S. Parke, John D. Biglands, Thomas Yates, Kamlesh Khunti, Melanie J. Davies, Gerry P. McCann
Diabetes Care 2020 Mar; dc200129. https://doi.org/10.2337/dc20-0129
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Abstract

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 (∼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, HbA1c 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 (β = 0.132, P = 0.002) but did not improve with the MRP (β = 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.

Footnotes

  • This article contains Supplementary Data online at https://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc20-0129/-/DC1.

  • Received January 19, 2020.
  • Accepted March 2, 2020.
  • © 2020 by the American Diabetes Association.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at https://www.diabetesjournals.org/content/license.

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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
Gaurav S. Gulsin, Daniel J. Swarbrick, Lavanya Athithan, Emer M. Brady, Joseph Henson, Emma Baldry, Stavroula Argyridou, Nishal B. Jaicim, Gareth Squire, Yvette Walters, Anna-Marie Marsh, John McAdam, Kelly S. Parke, John D. Biglands, Thomas Yates, Kamlesh Khunti, Melanie J. Davies, Gerry P. McCann
Diabetes Care Mar 2020, dc200129; DOI: 10.2337/dc20-0129

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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
Gaurav S. Gulsin, Daniel J. Swarbrick, Lavanya Athithan, Emer M. Brady, Joseph Henson, Emma Baldry, Stavroula Argyridou, Nishal B. Jaicim, Gareth Squire, Yvette Walters, Anna-Marie Marsh, John McAdam, Kelly S. Parke, John D. Biglands, Thomas Yates, Kamlesh Khunti, Melanie J. Davies, Gerry P. McCann
Diabetes Care Mar 2020, dc200129; DOI: 10.2337/dc20-0129
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© 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.