Impact of diabetes and diastolic dysfunction on exercise capacity in normotensive patients without coronary artery disease

Gürdal, Ahmet; Kaşıkçıoğlu, Erdem; Yakal, Sertaç; Buğra, Zehra

doi:10.1177/1479164114565631

Cited by 23 publications

(15 citation statements)

References 25 publications

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“…Similar VO 2 peak values compared to ours were found in a recent single centre study, with similar pre-and post-CR values and similar deficits of diabetic compared to non-diabetic patients [14]. The deficit in VO 2 peak found in our DM population was also reflected in lower VO 2 at the first ventilatory threshold and the VE/VCO 2 slope, consistent with what was documented previously [29,30]. Likewise, in our diabetic patients compared to those without DM, median peak heart rate was 4 bpm and 7 bpm lower at baseline and 12-month follow-up, respectively, and resting heart rate 2 bpm and 3 bpm higher, resulting in a 6 bpm and 10 bpm lower heart rate reserve, which may have, at least in part, accounted for the lower VO 2 peak.…”

Section: Vosupporting

confidence: 91%

Clinical outcomes after cardiac rehabilitation in elderly patients with and without diabetes mellitus: The EU-CaRE multicenter cohort study

Eser

Marcin

Prescott

et al. 2020

Cardiovasc Diabetol

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Background: The prevalence of patients with concomitant cardiovascular disease and diabetes mellitus (DM) is increasing rapidly. We aimed to compare the effectiveness of current cardiac rehabilitation (CR) programs across seven European countries between elderly cardiac patients with and without DM. Methods: 1633 acute and chronic coronary artery disease (CAD) patients and patients after valve intervention with an age 65 or above who participated in comprehensive CR (3 weeks to 3 months, depending on centre) were included. Peak oxygen uptake (VO 2 peak), body mass index, resting systolic blood pressure, low-density lipoproteincholesterol (LDL-C), and glycated haemoglobin (HbA1c) were assessed before start of CR, at termination of CR (variable time point), and 12 months after start of CR, with no intervention after CR. Baseline values and changes from baseline to 12-month follow-up were compared between patients with and without DM using mixed models, and mortality and hospitalisation rates using logistic regression. Results: 430 (26.3%) patients had DM. Patients with DM had more body fat, lower educational level, more comorbidities, cardiovascular risk factors, and more advanced CAD. Both groups increased their VO 2 peak over the study period but with a significantly lower improvement from baseline to follow-up in patients with DM. In the DM group, change in HbA1c was associated with weight change but not with change in absolute VO 2 peak. 12-month cardiac mortality was higher in patients with DM. Conclusions: While immediate improvements in VO 2 peak after CR in elderly patients with and without DM were similar, 12-month maintenance of this improvement was inferior in patients with DM, possibly related to disease progression. Glycemic control was less favourable in diabetic patients needing insulin in the short-and long-term. Since glycemic control was only related to weight loss but not to increase in exercise capacity, this highlights the importance of weight loss in obese DM patients during CR.

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Section: Vosupporting

confidence: 91%

Clinical outcomes after cardiac rehabilitation in elderly patients with and without diabetes mellitus: The EU-CaRE multicenter cohort study

Eser

Marcin

Prescott

et al. 2020

Cardiovasc Diabetol

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“…Our findings are consistent with those of aforementioned reports [14,15]. However, a more recent study by Gürdal et al reported that peak VO 2 in the maximum graded exercise test showed no statistically significant difference irrespective of the presence or absence of LV diastolic dysfunction in patients with type 2 diabetes and who had no apparent coronary artery disease [16]. Sacreet et al also reported that a 6-month exercise intervention successfully increased peak VO 2 by 11% in patients with type 2 diabetes.…”

Section: Subclinical Left Ventricular (Lv) Dysfunctionsupporting

confidence: 93%

Exercise Capacity of Patients with Type 2 Diabetes: a Mini Review of Clinical Findings

Yokoyama¹

2015

JED

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Open Access Mini Review diabetes. Regular exercise results in good glycemic control, weight loss, and an improvement in insulin sensitivity. In a joint position statement from the American Diabetes Association and the American College of Sports Medicine in 2010, exercise was recommended for most people with type 2 diabetes. Patients are particularly encouraged to engage in aerobic exercise at least three times per week. This entails a minimum period of 150 min a week combined with resistance training at least twice a week [5]. However, patients with diabetes are often sedentary. According to a survey of the US population including 23,283 people in 2003, compared with 58% of adults without diabetes, only 39% of adults with diabetes were physically active, i.e., engaged in more than 30 min of moderate or vigorous physical activity at least three times a week [6]. A UK study also revealed that two-thirds of patients with diabetes had not participated in any physical activity in the two weeks before the study [7]. Among these "inactive" patients, younger (< 60 years) patients stated that a lack of spare time or local facilities were the main barriers to exercise. In addition, they were less likely to exercise if they were tired.

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“…Previous studies showed that reduced physical activity and oxygen consumption are associated with diabetes ( Gürdal et al., 2015 ). Accordingly, we found less movement and decreased oxygen consumption in HFD mice, whereas, mice treated with combination treatment showed increased activity and significantly increased oxygen consumption.…”

Section: Discussionmentioning

confidence: 99%

Combination of Pancreastatin inhibitor PSTi8 with metformin inhibits Fetuin-A in type 2 diabetic mice

Singh

Garg

Goand

et al. 2020

Heliyon

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In the preceding study, we delineated that high-fat diet (HFD) consumption in mice increases the circulatory level of pancreastatin (PST), which additionally enhances the free fatty acid (FFA) concentration in circulation. Consequently, the aggravated FFA activates Fetuin-A, which facilitates hepatic lipid accumulation, insulin resistance (IR), and culminates in type 2 diabetes (T2D). Metformin (Met) is a widely known first-line drug for the treatment of T2D. We previously unveiled PSTi8, an inhibitor of PST, comprising antidiabetic property. Hence, we hypothesized that combination therapy of Met and PSTi8, at reduced therapeutic doses, would mitigate HFD-induced IR by inhibiting hepatic Fetuin-A in mice model of T2D. C57BL/6 mice were fed HFD for 12 weeks, followed by treatment with Met, PSTi8, and its combination for 10 days. Glucose and insulin tolerance tests were conducted. Circulatory levels of PST, Fetuin-A, and lipid markers were determined. Also, the mRNA and protein expression of Fetuin-A was assessed by qPCR, western blotting, and immunofluorescence. Moreover, the energy expenditure was measured by comprehensive laboratory animal monitoring system (CLAMS). Combination therapy displayed improved PST, Fetuin-A, and lipid profile in plasma. We also found reduced hepatic Fetuin-A, which reduced inhibitory phosphorylation of IRS and increased phosphorylation of AKT. Consequently, ameliorated hepatic lipogenesis, gluconeogenesis, and inflammation. Also, combination treatment attenuated Fetuin-A expression, lipid accumulation, and glucose production in palmitate-induced HepG2 cells. Altogether current study promulgates the beneficial effect of combination therapy of Met and PSTi8 (comparable to alone higher therapeutic doses) to ameliorate Fetuin-A activation, hepatic lipid accumulation, insulin resistance, and associated progressive pathophysiological alterations in T2D.

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Impact of diabetes and diastolic dysfunction on exercise capacity in normotensive patients without coronary artery disease

Abstract: Exercise capacity was found to be significantly decreased in normotensive patients with type 2 diabetes without coronary artery disease, and this decrease was independent of diastolic dysfunction.

Cited by 23 publications

References 25 publications

Clinical outcomes after cardiac rehabilitation in elderly patients with and without diabetes mellitus: The EU-CaRE multicenter cohort study

Clinical outcomes after cardiac rehabilitation in elderly patients with and without diabetes mellitus: The EU-CaRE multicenter cohort study

Exercise Capacity of Patients with Type 2 Diabetes: a Mini Review of Clinical Findings

Combination of Pancreastatin inhibitor PSTi8 with metformin inhibits Fetuin-A in type 2 diabetic mice

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