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Ayton SL, Yeo JL, Gulsin GS, Dattani A, Bilak J, Deshpande A, Arnold JR, Singh A, Graham-Brown MPM, Ng L, Jones D, Slomka P, Dey D, Moss AJ, Brady EM, McCann GP. Association of epicardial adipose tissue with early structural and functional cardiac changes in Type 2 diabetes. Eur J Radiol 2024; 174:111400. [PMID: 38458143 DOI: 10.1016/j.ejrad.2024.111400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/29/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Dysregulated epicardial adipose tissue (EAT) may contribute to the development of heart failure in Type 2 diabetes (T2D). This study aimed to evaluate the associations between EAT volume and composition with imaging markers of subclinical cardiac dysfunction in people with T2D and no prevalent cardiovascular disease. METHODS Prospective case-control study enrolling participants with and without T2D and no known cardiovascular disease. Two hundred and fifteen people with T2D (median age 63 years, 60 % male) and thirty-nine non-diabetics (median age 59 years, 62 % male) were included. Using computed tomography (CT), total EAT volume and mean CT attenuation, as well as, low attenuation (Hounsfield unit range -190 to -90) EAT volume were quantified by a deep learning method and volumes indexed to body surface area. Associations with cardiac magnetic resonance-derived left ventricular (LV) volumes and strain indices were assessed using linear regression. RESULTS T2D participants had higher LV mass/volume ratio (median 0.89 g/mL [0.82-0.99] vs 0.79 g/mL [0.75-0.89]) and lower global longitudinal strain (GLS; 16.1 ± 2.3 % vs 17.2 ± 2.2 %). Total indexed EAT volume correlated inversely with mean CT attenuation. Low attenuation indexed EAT volume was 2-fold higher (18.8 cm3/m2 vs. 9.4 cm3/m2, p < 0.001) in T2D and independently associated with LV mass/volume ratio (ß = 0.002, p = 0.01) and GLS (ß = -0.03, p = 0.03). CONCLUSIONS Higher EAT volumes seen in T2D are associated with a lower mean CT attenuation. Low attenuation indexed EAT volume is independently, but only weakly, associated with markers of subclinical cardiac dysfunction in T2D.
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Affiliation(s)
- Sarah L Ayton
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Jian L Yeo
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Abhishek Dattani
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Joanna Bilak
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Aparna Deshpande
- Department of Imaging Services, Glenfield Hospital, University Hospitals of Leicester, Leicester UK
| | - J Ranjit Arnold
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Matthew P M Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Leong Ng
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK; Leicester van Geest Multi-Omics Facility, University of Leicester, Leicester, UK
| | - Donald Jones
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK; Leicester van Geest Multi-Omics Facility, University of Leicester, Leicester, UK
| | - Piotr Slomka
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alastair J Moss
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK; Leicester van Geest Multi-Omics Facility, University of Leicester, Leicester, UK
| | - Emer M Brady
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK.
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Guan H, Tian J, Wang Y, Niu P, Zhang Y, Zhang Y, Fang X, Miao R, Yin R, Tong X. Advances in secondary prevention mechanisms of macrovascular complications in type 2 diabetes mellitus patients: a comprehensive review. Eur J Med Res 2024; 29:152. [PMID: 38438934 PMCID: PMC10910816 DOI: 10.1186/s40001-024-01739-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/21/2024] [Indexed: 03/06/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) poses a significant global health burden. This is particularly due to its macrovascular complications, such as coronary artery disease, peripheral vascular disease, and cerebrovascular disease, which have emerged as leading contributors to morbidity and mortality. This review comprehensively explores the pathophysiological mechanisms underlying these complications, protective strategies, and both existing and emerging secondary preventive measures. Furthermore, we delve into the applications of experimental models and methodologies in foundational research while also highlighting current research limitations and future directions. Specifically, we focus on the literature published post-2020 concerning the secondary prevention of macrovascular complications in patients with T2DM by conducting a targeted review of studies supported by robust evidence to offer a holistic perspective.
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Affiliation(s)
- Huifang Guan
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, China
| | - Jiaxing Tian
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.
| | - Ying Wang
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, China
| | - Ping Niu
- Rehabilitation Department, The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, 130021, China
| | - Yuxin Zhang
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Yanjiao Zhang
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Xinyi Fang
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
- Graduate College, Beijing University of Chinese Medicine, Beijing, China
| | - Runyu Miao
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
- Graduate College, Beijing University of Chinese Medicine, Beijing, China
| | - Ruiyang Yin
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Xiaolin Tong
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.
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Ning Y, Yuan Z, Wang Q, He J, Zhu W, Ren DN, Wo D. Epigallocatechin-3-gallate promotes wound healing response in diabetic mice by activating keratinocytes and promoting re-epithelialization. Phytother Res 2024; 38:1013-1027. [PMID: 38140774 DOI: 10.1002/ptr.8099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/07/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023]
Abstract
Type 2 diabetes (T2D) is a metabolic disorder that causes numerous complications including impaired wound healing and poses a significant challenge for the management of diabetic patients. Epigallocatechin-3-gallate (EGCG) is a natural polyphenol that exhibits anti-inflammatory and anti-oxidative benefits in skin wounds, however, the direct effect of EGCG on epidermal keratinocytes, the primary cells required for re-epithelialization in wound healing remains unknown. Our study aims to examine the underlying mechanisms of EGCG's ability to promote re-epithelialization and wound healing in T2D-induced wounds. Murine models of wound healing in T2D were established via feeding high-fat high-fructose diet (HFFD) and the creation of full-thickness wounds. Mice were administered daily with EGCG or vehicle to examine the wound healing response and underlying molecular mechanisms of EGCG's protective effects. Systemic administration of EGCG in T2D mice robustly accelerated the wound healing response following injury. EGCG induced nuclear translocation of nuclear factor erythroid 2-related factor 2 (NRF2) and promoted cytokeratin 16 (K16) expression to activate epidermal keratinocytes and robustly promoted re-epithelialization of wounds in diabetic mice. Further, EGCG demonstrated high binding affinity with Kelch-like ECH-associated protein 1 (KEAP1), thereby inhibiting KEAP1-mediated degradation of NRF2. Our findings provide important evidence that EGCG accelerates the wound healing response in diabetic mice by activating epidermal keratinocytes, thereby promoting re-epithelialization of wounds via K16/NRF2/KEAP1 signaling axis. These mechanistic insights into the protective effects of EGCG further suggest its therapeutic potential as a promising drug for treating chronic wounds in T2D.
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Affiliation(s)
- Yongling Ning
- Academy of Integrative Medicine, Fujian Key Laboratory of Integrative Medicine on Geriatric, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Zhiying Yuan
- Academy of Integrative Medicine, Fujian Key Laboratory of Integrative Medicine on Geriatric, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Qing Wang
- Academy of Integrative Medicine, Fujian Key Laboratory of Integrative Medicine on Geriatric, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jia He
- Academy of Integrative Medicine, Fujian Key Laboratory of Integrative Medicine on Geriatric, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Innovation and Transformation Center, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Weidong Zhu
- Academy of Integrative Medicine, Fujian Key Laboratory of Integrative Medicine on Geriatric, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Innovation and Transformation Center, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Dan-Ni Ren
- Academy of Integrative Medicine, Fujian Key Laboratory of Integrative Medicine on Geriatric, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Da Wo
- Academy of Integrative Medicine, Fujian Key Laboratory of Integrative Medicine on Geriatric, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Innovation and Transformation Center, Fujian University of Traditional Chinese Medicine, Fuzhou, China
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Cai X, Liu M, Xu X, Zhang S, Huang R, Wang P, He L, Chen Z, Liu Z, Zhou Y, Guo Y, Zhuang X, Liao X. Cardiovascular effects of weight loss in old adults with overweight/obesity according to change in skeletal muscle mass. J Cachexia Sarcopenia Muscle 2024; 15:342-351. [PMID: 38108096 PMCID: PMC10834329 DOI: 10.1002/jcsm.13409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/24/2023] [Accepted: 09/22/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Patients with overweight/obesity and type 2 diabetes are encouraged to lose weight, but not all losing weight gain better cardiovascular health, especially old adults. The change in skeletal muscle mass (SMM) could be the key that explains the heterogenous cardiovascular effects of weight loss. This study aims to assess whether the cardiovascular effects of weight loss vary for those gaining skeletal muscle along with weight loss. METHODS The old adults with overweight/obesity and type 2 diabetes in the Look AHEAD study having muscle measurement from dual-energy X-ray absorptiometry were included. Based on the weight change (WC) and SMM change (SMMC) between baseline and the 4-year follow-up, participants were allocated into three groups-weight gain (WG) group, weight loss with muscle loss (WL-ML) group and weight loss with muscle gain (WL-MG) group. Cox proportional hazards regression was performed to evaluate the cardiovascular risk of those gaining or losing SMM with weight loss compared with those gaining weight. Among the participants with weight loss, the ratio of SMMC/WC was calculated, and the association of SMMC/WC with primary cardiovascular outcome was assessed. RESULTS A total of 491 participants were included in the study with an average age of 64.56 ± 3.81 years old. A total of 47.0% were male and 49.9% were from the intensive lifestyle intervention arm. Based on their WC and SMMC, 43 were assigned to the WG group, 373 to the WL-ML group and 75 to the WL-MG group. Over a follow-up of almost 10 years, 97 participants encountered the primary endpoint. The WG group had the highest incidence of 25.59%, the WL-MG group had the lowest incidence of 9.33% and the WL-ML group had 21.18% (P = 0.040). In the fourth adjusted Cox model, the WL-MG group achieved significantly decreased odds of the primary endpoint compared with the WG group (hazard ratio [HR] 0.33, 95% confidence interval [CI] [0.12, 0.87], P = 0.026), whilst the WL-ML group did not (HR 0.91, 95% CI [0.47, 1.78], P = 0.670). Among the participants with weight loss, when SMMC/WC reached around 50%, this HR soared to approximately two-fold. CONCLUSIONS The participants gaining SMM along with weight loss achieved the lowest odds of adverse cardiovascular events, whilst those who lost SMM along with weight loss had comparable cardiovascular risk with those gaining weight. The more muscle lost during weight loss, the greater the harm. The cardiovascular effects of weight loss were modulated by whether the participants gained SMM meanwhile losing weight.
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Affiliation(s)
- Xiaojie Cai
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Menghui Liu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xingfeng Xu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Shaozhao Zhang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Rihua Huang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Peng Wang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Lixiang He
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Zhuohui Chen
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Zishan Liu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yi Zhou
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yue Guo
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xiaodong Zhuang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xinxue Liao
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
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D’Haese S, Claes L, de Laat I, Van Campenhout S, Deluyker D, Heeren E, Haesen S, Lambrichts I, Wouters K, Schalkwijk CG, Hansen D, Eijnde BO, Bito V. Moderate-Intensity and High-Intensity Interval Exercise Training Offer Equal Cardioprotection, with Different Mechanisms, during the Development of Type 2 Diabetes in Rats. Nutrients 2024; 16:431. [PMID: 38337716 PMCID: PMC10856993 DOI: 10.3390/nu16030431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Endurance exercise training is a promising cardioprotective strategy in type 2 diabetes mellitus (T2DM), but the impact of its intensity is not clear. We aimed to investigate whether and how isocaloric moderate-intensity exercise training (MIT) and high-intensity interval exercise training (HIIT) could prevent the adverse cardiac remodeling and dysfunction that develop T2DM in rats. Male rats received a Western diet (WD) to induce T2DM and underwent a sedentary lifestyle (n = 7), MIT (n = 7) or HIIT (n = 8). Insulin resistance was defined as the HOMA-IR value. Cardiac function was assessed with left ventricular (LV) echocardiography and invasive hemodynamics. A qPCR and histology of LV tissue unraveled underlying mechanisms. We found that MIT and HIIT halted T2DM development compared to in sedentary WD rats (p < 0.05). Both interventions prevented increases in LV end-systolic pressure, wall thickness and interstitial collagen content (p < 0.05). In LV tissue, HIIT tended to upregulate the gene expression of an ROS-generating enzyme (NOX4), while both modalities increased proinflammatory macrophage markers and cytokines (CD86, TNF-α, IL-1β; p < 0.05). HIIT promoted antioxidant and dicarbonyl defense systems (SOD2, glyoxalase 1; p < 0.05) whereas MIT elevated anti-inflammatory macrophage marker expression (CD206, CD163; p < 0.01). We conclude that both MIT and HIIT limit WD-induced T2DM with diastolic dysfunction and pathological LV hypertrophy, possibly using different adaptive mechanisms.
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Affiliation(s)
- Sarah D’Haese
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.); (D.D.); (E.H.); (S.H.); (I.L.)
- Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands; (K.W.); (C.G.S.)
| | - Lisa Claes
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.); (D.D.); (E.H.); (S.H.); (I.L.)
| | - Iris de Laat
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.); (D.D.); (E.H.); (S.H.); (I.L.)
| | - Sven Van Campenhout
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.); (D.D.); (E.H.); (S.H.); (I.L.)
| | - Dorien Deluyker
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.); (D.D.); (E.H.); (S.H.); (I.L.)
| | - Ellen Heeren
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.); (D.D.); (E.H.); (S.H.); (I.L.)
| | - Sibren Haesen
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.); (D.D.); (E.H.); (S.H.); (I.L.)
| | - Ivo Lambrichts
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.); (D.D.); (E.H.); (S.H.); (I.L.)
| | - Kristiaan Wouters
- Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands; (K.W.); (C.G.S.)
| | - Casper G. Schalkwijk
- Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands; (K.W.); (C.G.S.)
| | - Dominique Hansen
- UHasselt, Faculty of Rehabilitation Sciences, REVAL Rehabilitation Research Centre, Agoralaan, 3590 Diepenbeek, Belgium;
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - BO Eijnde
- SMRc-Sports Medicine Research Center, BIOMED-Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, 3500 Diepenbeek, Belgium;
- Division of Sport Science, Stellenbosch University, Stellenbosch 7602, South Africa
| | - Virginie Bito
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.); (D.D.); (E.H.); (S.H.); (I.L.)
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Brady EM, Cao TH, Moss AJ, Athithan L, Ayton SL, Redman E, Argyridou S, Graham-Brown MPM, Maxwell CB, Jones DJL, Ng L, Yates T, Davies MJ, McCann GP, Gulsin GS. Circulating sphingolipids and relationship to cardiac remodelling before and following a low-energy diet in asymptomatic Type 2 Diabetes. BMC Cardiovasc Disord 2024; 24:25. [PMID: 38172712 PMCID: PMC10765891 DOI: 10.1186/s12872-023-03623-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is a heterogenous multi-system syndrome with limited efficacious treatment options. The prevalence of Type 2 diabetes (T2D) continues to rise and predisposes patients to HFpEF, and HFpEF remains one of the biggest challenges in cardiovascular medicine today. Novel therapeutic targets are required to meet this important clinical need. Deep phenotyping studies including -OMIC analyses can provide important pathogenic information to aid the identification of such targets. The aims of this study were to determine; 1) the impact of a low-energy diet on plasma sphingolipid/ceramide profiles in people with T2D compared to healthy controls and, 2) if the change in sphingolipid/ceramide profile is associated with reverse cardiovascular remodelling. METHODS Post-hoc analysis of a randomised controlled trial (NCT02590822) including adults with T2D with no cardiovascular disease who completed a 12-week low-energy (∼810 kcal/day) meal-replacement plan (MRP) and matched healthy controls (HC). Echocardiography, cardiac MRI and a fasting blood for lipidomics were undertaken pre/post-intervention. Candidate biomarkers were identified from case-control comparison (fold change > 1.5 and statistical significance p < 0.05) and their response to the MRP reported. Association between change in biomarkers and change indices of cardiac remodelling were explored. RESULTS Twenty-four people with T2D (15 males, age 51.1 ± 5.7 years), and 25 HC (15 male, 48.3 ± 6.6 years) were included. Subjects with T2D had increased left ventricular (LV) mass:volume ratio (0.84 ± 0.13 vs. 0.70 ± 0.08, p < 0.001), increased systolic function but impaired diastolic function compared to HC. Twelve long-chain polyunsaturated sphingolipids, including four ceramides, were downregulated in subjects with T2D at baseline. Three sphingomyelin species and all ceramides were inversely associated with LV mass:volume. There was a significant increase in all species and shift towards HC following the MRP, however, none of these changes were associated with reverse cardiac remodelling. CONCLUSION The lack of association between change in sphingolipids/ceramides and reverse cardiac remodelling following the MRP casts doubt on a causative role of sphingolipids/ceramides in the progression of heart failure in T2D. TRIAL REGISTRATION NCT02590822.
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Affiliation(s)
- Emer M Brady
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
- Leicester Van Geest Multi-Omics Facility, University of Leicester, Leicester, UK
| | - Thong H Cao
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
- Leicester Van Geest Multi-Omics Facility, University of Leicester, Leicester, UK
| | - Alastair J Moss
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
- Leicester Van Geest Multi-Omics Facility, University of Leicester, Leicester, UK
| | - Lavanya Athithan
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Sarah L Ayton
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Emma Redman
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Stavroula Argyridou
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Matthew P M Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Colleen B Maxwell
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
- Leicester Van Geest Multi-Omics Facility, University of Leicester, Leicester, UK
| | - Donald J L Jones
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
- Leicester Van Geest Multi-Omics Facility, University of Leicester, Leicester, UK
| | - Leong Ng
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
- Leicester Van Geest Multi-Omics Facility, University of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
- Leicester Van Geest Multi-Omics Facility, University of Leicester, Leicester, UK
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK.
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7
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Dattani A, Singh A, McCann GP, Gulsin GS. Myocardial Calcium Handling in Type 2 Diabetes: A Novel Therapeutic Target. J Cardiovasc Dev Dis 2023; 11:12. [PMID: 38248882 PMCID: PMC10817027 DOI: 10.3390/jcdd11010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Type 2 diabetes (T2D) is a multisystem disease with rapidly increasing global prevalence. Heart failure has emerged as a major complication of T2D. Dysregulated myocardial calcium handling is evident in the failing heart and this may be a key driver of cardiomyopathy in T2D, but until recently this has only been demonstrated in animal models. In this review, we describe the physiological concepts behind calcium handling within the cardiomyocyte and the application of novel imaging techniques for the quantification of myocardial calcium uptake. We take an in-depth look at the evidence for the impairment of calcium handling in T2D using pre-clinical models as well as in vivo studies, following which we discuss potential novel therapeutic approaches targeting dysregulated myocardial calcium handling in T2D.
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Affiliation(s)
- Abhishek Dattani
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (A.S.); (G.P.M.); (G.S.G.)
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Bohoran TA, Parke KS, Graham-Brown MPM, Meisuria M, Singh A, Wormleighton J, Adlam D, Gopalan D, Davies MJ, Williams B, Brown M, McCann GP, Giannakidis A. Resource efficient aortic distensibility calculation by end to end spatiotemporal learning of aortic lumen from multicentre multivendor multidisease CMR images. Sci Rep 2023; 13:21794. [PMID: 38066222 PMCID: PMC10709583 DOI: 10.1038/s41598-023-48986-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
Aortic distensibility (AD) is important for the prognosis of multiple cardiovascular diseases. We propose a novel resource-efficient deep learning (DL) model, inspired by the bi-directional ConvLSTM U-Net with densely connected convolutions, to perform end-to-end hierarchical learning of the aorta from cine cardiovascular MRI towards streamlining AD quantification. Unlike current DL aortic segmentation approaches, our pipeline: (i) performs simultaneous spatio-temporal learning of the video input, (ii) combines the feature maps from the encoder and decoder using non-linear functions, and (iii) takes into account the high class imbalance. By using multi-centre multi-vendor data from a highly heterogeneous patient cohort, we demonstrate that the proposed method outperforms the state-of-the-art method in terms of accuracy and at the same time it consumes [Formula: see text] 3.9 times less fuel and generates [Formula: see text] 2.8 less carbon emissions. Our model could provide a valuable tool for exploring genome-wide associations of the AD with the cognitive performance in large-scale biomedical databases. By making energy usage and carbon emissions explicit, the presented work aligns with efforts to keep DL's energy requirements and carbon cost in check. The improved resource efficiency of our pipeline might open up the more systematic DL-powered evaluation of the MRI-derived aortic stiffness.
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Affiliation(s)
- Tuan Aqeel Bohoran
- School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, UK
| | - Kelly S Parke
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Matthew P M Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Mitul Meisuria
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Joanne Wormleighton
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - David Adlam
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Deepa Gopalan
- Imperial College London & Cambridge University Hospitals, Cambridge, CB2 0QQ, UK
| | - Melanie J Davies
- Leicester Diabetes Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London (UCL), National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, London, WC1E 6DD, UK
| | - Morris Brown
- Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Archontis Giannakidis
- School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, UK.
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9
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Dattani A, Joshi S, Yeo JL, Singh A, Brady EM, Parke KS, Arnold JR, Singh T, Kershaw LE, Spath NB, Reynolds RM, Forbes S, Gibb FW, Semple SI, Dweck MR, Newby DE, McCann GP, Gulsin GS. Impaired Myocardial Calcium Uptake in Patients With Diabetes Mellitus: A Manganese-Enhanced Cardiac Magnetic Resonance Study. JACC Cardiovasc Imaging 2023; 16:1623-1625. [PMID: 37389510 DOI: 10.1016/j.jcmg.2023.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/07/2023] [Accepted: 05/10/2023] [Indexed: 07/01/2023]
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10
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Ye W, Xu L, Ye Y, Zeng F, Lu X, Li Y, Liu L. Efficacy and Safety of Meal Replacement in Patients With Type 2 Diabetes. J Clin Endocrinol Metab 2023; 108:3041-3049. [PMID: 37192345 DOI: 10.1210/clinem/dgad273] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 05/18/2023]
Abstract
CONTEXT Meal replacement (MR) is beneficial for the management of type 2 diabetes (T2D). However, MR prescription and patient characteristics vary substantially between studies using MR in T2D patients. OBJECTIVE This work aimed to evaluate the efficacy and safety of MR in T2D patients by meta-analysis, with a focus on subgroup analysis of variable participant characteristics and MR prescription. METHODS We searched PubMed, CENTRAL, Embase, Web of Science, and the clinical trial registration database up to March 2022. We included randomized controlled trials (RCTs) of 2 weeks or more assessing the effect and safety of MR in T2D patients in comparison with conventional diabetic diets (CDs). RESULTS A total of 17 RCTs involving 2112 participants were ultimately included. Compared with CDs, MR significantly reduced glycated hemoglobin A1c (HbA1c) (MD -0.46%; P < .001), fasting blood glucose (FBG, -0.62 mmol/L; P < .001), body weight (-2.43 kg; P < .001), and body mass index (BMI, -0.65; P < .001), and improved other cardiometabolic risk factors. In subgroup analyses, total MR showed greater improvement in HbA1c (-0.72% vs -0.32%; P = .01), FBG (-1.45 vs -0.56 mmol/L; P = .02), body weight (-6.57 vs -1.58 kg; P < .001), and BMI (-2.78 vs -0.37; P < .001) than partial MR. MR with caloric restriction showed more reduction in body weight (-3.20 vs -0.75 kg; P < .001) and BMI (-0.84 vs -0.24; P = .003) compared with those without caloric restriction. MR showed similar benefits in studies that included patients using insulin and those that did not. Both partial and total MR were well tolerated. CONCLUSION Compared with CDs, the MR-based dietary pattern further improved the glycemic control and adipose indicators in T2D patients. Appropriate calorie restriction and total MR might be more beneficial, while both patients treated with or without insulin treatment could similarly benefit from MR usage.
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Affiliation(s)
- Wenjing Ye
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Lijuan Xu
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Yanbin Ye
- Department of Clinical Nutrition, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, China
| | - Fangfang Zeng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangdong, 510632, China
| | - Xin Lu
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Yanbing Li
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Liehua Liu
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
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11
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Lee DC, Orstad SL, Kanchi R, Adhikari S, Rummo PE, Titus AR, Aleman JO, Elbel B, Thorpe LE, Schwartz MD. Demographic, social and geographic factors associated with glycaemic control among US Veterans with new onset type 2 diabetes: a retrospective cohort study. BMJ Open 2023; 13:e075599. [PMID: 37832984 PMCID: PMC10582880 DOI: 10.1136/bmjopen-2023-075599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/07/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVES This study evaluated whether a range of demographic, social and geographic factors had an influence on glycaemic control longitudinally after an initial diagnosis of diabetes. DESIGN, SETTING AND PARTICIPANTS We used the US Veterans Administration Diabetes Risk national cohort to track glycaemic control among patients 20-79-year old with a new diagnosis of type 2 diabetes. PRIMARY OUTCOME AND METHODS We modelled associations between glycaemic control at follow-up clinical assessments and geographic factors including neighbourhood race/ethnicity, socioeconomic, land use and food environment measures. We also adjusted for individual demographics, comorbidities, haemoglobin A1c (HbA1c) at diagnosis and duration of follow-up. These factors were analysed within strata of community type: high-density urban, low-density urban, suburban/small town and rural areas. RESULTS We analysed 246 079 Veterans who developed a new type 2 diabetes diagnosis in 2008-2018 and had at least 2 years of follow-up data available. Across all community types, we found that lower baseline HbA1c and female sex were strongly associated with a higher likelihood of within-range HbA1c at follow-up. Surprisingly, patients who were older or had more documented comorbidities were more likely to have within-range follow-up HbA1c results. While there was variation by community type, none of the geographic measures analysed consistently demonstrated significant associations with glycaemic control across all community types.
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Affiliation(s)
- David C Lee
- Emergency Medicine, NYU Grossman School of Medicine, New York City, New York, USA
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - Stephanie L Orstad
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
- Medicine, NYU Grossman School of Medicine, New York City, New York, USA
| | - Rania Kanchi
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - Samrachana Adhikari
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - Pasquale E Rummo
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - Andrea R Titus
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - Jose O Aleman
- Medicine, NYU Grossman School of Medicine, New York City, New York, USA
- Veterans Affairs, VA New York Harbor Healthcare System, New York City, New York, USA
| | - Brian Elbel
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
- Wagner Graduate School of Public Service, NYU, New York City, New York, USA
| | - Lorna E Thorpe
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - Mark D Schwartz
- Population Health, NYU Grossman School of Medicine, New York City, New York, USA
- Veterans Affairs, VA New York Harbor Healthcare System, New York City, New York, USA
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12
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Athithan L, Gulsin GS, Henson J, Althagafi L, Redman E, Argyridou S, Parke KS, Yeo J, Yates T, Khunti K, Davies MJ, McCann GP, Brady EM. Response to a low-energy meal replacement plan on glycometabolic profile and reverse cardiac remodelling in type 2 diabetes: a comparison between South Asians and White Europeans. Ther Adv Endocrinol Metab 2023; 14:20420188231193231. [PMID: 37811525 PMCID: PMC10559709 DOI: 10.1177/20420188231193231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/21/2023] [Indexed: 10/10/2023] Open
Abstract
Background South Asians (SA) constitute a quarter of the global population and are disproportionally affected by both type 2 diabetes (T2D) and heart failure. There remains limited data of the acceptability and efficacy of low-energy meal replacement plans to induce remission of T2D in SA. Objectives The objective of this exploratory secondary analysis of the DIASTOLIC study was to determine if there was a differential uptake, glycometabolic and cardiovascular response to a low-energy meal replacement plan (MRP) between SA and White European (WE) people with T2D. Methods Obese adults with T2D without symptomatic cardiovascular disease were allocated a low-energy (~810 kcal/day) MRP as part of the DIASTOLIC study (NCT02590822). Comprehensive multiparametric cardiovascular magnetic resonance imaging, echocardiography, cardiopulmonary exercise testing and metabolic profiling were undertaken at baseline and 12 weeks. A comparison of change at 12 weeks between groups with baseline adjustment was undertaken. Results Fifteen WE and 12 SAs were allocated the MRP. All WE participants completed the MRP versus 8/12 (66%) SAs. The degree of concentric left ventricular remodelling was similar between ethnicities. Despite similar weight loss and reduction in liver fat percentage, SA had a lower reduction in Homeostatic Model Assessment for Insulin Resistance [-5.7 (95% CI: -7.3, -4.2) versus -8.6 (-9.7, -7.6), p = 0.005] and visceral adiposity compared to WE [-0.43% (-0.61, -0.25) versus -0.80% (-0.91, -0.68), p = 0.002]. Exercise capacity increased in WE with no change observed in SA. There was a trend towards more reverse remodelling in WE compared to SAs. Conclusions Compliance to the MRP was lower in SA versus WE. Overall, those completing the MRP saw improvements in weight, body composition and indices of glycaemic control irrespective of ethnicity. Whilst improvements in VAT and insulin resistance appear to be dampened in SA versus WE, given the small sample, larger studies are required to confirm or challenge this potential ethnic disparity. Trail registration NCT02590822.
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Affiliation(s)
- Lavanya Athithan
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gaurav S. Gulsin
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Joseph Henson
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, General Hospital, Leicester, UK
| | - Loai Althagafi
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Emma Redman
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, General Hospital, Leicester, UK
| | - Stavroula Argyridou
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, General Hospital, Leicester, UK
| | - Kelly S. Parke
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Jian Yeo
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, General Hospital, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, General Hospital, Leicester, UK
| | - Melanie J. Davies
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, General Hospital, Leicester, UK
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Emer M. Brady
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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13
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Macedo ACPD, Schaan CW, Bock PM, Pinto MBD, Botton CE, Umpierre D, Schaan BD. Cardiorespiratory fitness in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:e230040. [PMID: 37738467 PMCID: PMC10665050 DOI: 10.20945/2359-4292-2023-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 05/30/2023] [Indexed: 09/24/2023]
Abstract
Objective To conduct a systematic review and meta-analysis assessing the cardiorespiratory fitness (CRF) among individuals with and without type 2 diabetes. Materials and methods The current review was registered in PROSPERO under the number CRD42018082718. MEDLINE, EMBASE, and Cochrane Library databases were searched from inception through February 2022. Eligibility criteria consisted of observational or interventional studies that evaluated CRF through cardiopulmonary exercise testing or six-minute walk test in individuals with type 2 diabetes compared with individuals without type 2 diabetes. For data extraction, we used baseline CRF assessments of randomized clinical trials or follow-up CRF assessments in observational studies. We performed a meta-analysis using maximal oxygen consumption (VO2 max), and distance walked in the 6MWT as primary outcomes. They were extracted and expressed as mean differences (MDs) and 95% CIs between treatment and comparator groups. The meta-analysis was conducted using Review Manager (RevMan) software. Results Out of 8,347 studies retrieved, 77 were included. Compared with individuals without type 2 diabetes, individuals with diabetes achieved a lower VO2 max (-5.84 mL.kg-1.min-1, 95% CI -6.93, -4.76 mL.kg-1.min-1, p = <0.0001; I2 = 91%, p for heterogeneity < 0.0001), and a smaller distance walked in 6MWT (-93.30 meters, 95% CI -141.2, -45.4 meters, p > 0.0001; I2: 94%, p for heterogeneity < 0.0001). Conclusion Type 2 diabetes was associated with lower cardiorespiratory fitness, as observed by lower VO2 max on maximal tests, and smaller distance walked in 6MWT, however the quality of studies was low.
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Affiliation(s)
- Aline Chagastelles Pinto de Macedo
- Universidade Federal do Rio Grande do Sul, Programa de Pós-graduaçÃo em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brasil
- Laboratório de Atividade Física, Diabetes e Doença Cardiovascular (LADD), Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Camila Wohlgemuth Schaan
- Laboratório de Atividade Física, Diabetes e Doença Cardiovascular (LADD), Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Patricia Martins Bock
- Laboratório de Atividade Física, Diabetes e Doença Cardiovascular (LADD), Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil,
- Faculdades Integradas de Taquara, Taquara, RS, Brasil
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Mariana Brutto de Pinto
- Laboratório de Atividade Física, Diabetes e Doença Cardiovascular (LADD), Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Cintia Ehlers Botton
- Instituto de AvaliaçÃo de Tecnologia em Saúde (IATS) - CNPq/Brasil, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
- Universidade Federal do Ceará, Instituto de EducaçÃo Física e Esportes, Fortaleza, CE, Brasil
- Programa de Mestrado em Fisioterapia e Funcionalidade, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - Daniel Umpierre
- Laboratório de Atividade Física, Diabetes e Doença Cardiovascular (LADD), Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
- Instituto de AvaliaçÃo de Tecnologia em Saúde (IATS) - CNPq/Brasil, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Beatriz D Schaan
- Universidade Federal do Rio Grande do Sul, Programa de Pós-graduaçÃo em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brasil
- Laboratório de Atividade Física, Diabetes e Doença Cardiovascular (LADD), Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
- Instituto de AvaliaçÃo de Tecnologia em Saúde (IATS) - CNPq/Brasil, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
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14
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Affiliation(s)
- Yigal M Pinto
- From the Departments of Clinical Cardiology and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam
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15
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Bletsa E, Oikonomou E, Dimitriadis K, Stampouloglou PK, Fragoulis C, Lontou SP, Korakas E, Beneki E, Kalogeras K, Lambadiari V, Tsioufis K, Vavouranakis M, Siasos G. Exercise Effects on Left Ventricular Remodeling in Patients with Cardiometabolic Risk Factors. Life (Basel) 2023; 13:1742. [PMID: 37629599 PMCID: PMC10456116 DOI: 10.3390/life13081742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Left ventricular (LV) remodeling is a dynamic process, which is characterized by changes in ventricular size, shape, and wall thickness, thus altering myocardial geometry and function, and is considered as a negative prognostic factor in patients with heart failure (HF). Hypertension, type 2 diabetes (T2D), and obesity are strongly correlated with the development and the progression of LV remodeling, LV hypertrophy, and LV systolic and/or diastolic dysfunction. Indeed, the beneficial impact of exercise training on primary and secondary prevention of cardiovascular disease (CVD) has been well-established. Recent studies have highlighted that exercise training enhances functional capacity, muscle strength and endurance, cardiac function, and cardiac-related biomarkers among patients with established coronary artery disease (CAD) or HF, thus substantially improving their cardiovascular prognosis, survival rates, and need for rehospitalization. Therefore, in this review article, we discuss the evidence of LV remodeling in patients with cardiometabolic risk factors, such as hypertension, T2D, and obesity, and also highlight the current studies evaluating the effect of exercise training on LV remodeling in these patients.
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Affiliation(s)
- Evanthia Bletsa
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
| | - Kyriakos Dimitriadis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece; (K.D.); (C.F.); (E.B.); (K.T.)
| | - Panagiota K. Stampouloglou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
| | - Christos Fragoulis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece; (K.D.); (C.F.); (E.B.); (K.T.)
- Heart and Diabetes Center, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece;
| | - Stavroula P. Lontou
- Heart and Diabetes Center, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece;
| | - Emmanouil Korakas
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
- 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Eirini Beneki
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece; (K.D.); (C.F.); (E.B.); (K.T.)
| | - Konstantinos Kalogeras
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
| | - Vaia Lambadiari
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
- 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece; (K.D.); (C.F.); (E.B.); (K.T.)
- Heart and Diabetes Center, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece;
| | - Manolis Vavouranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
| | - Gerasimos Siasos
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
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16
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Dattani A, Brady EM, Alfuhied A, Gulsin GS, Steadman CD, Yeo JL, Aslam S, Banovic M, Jerosch-Herold M, Xue H, Kellman P, Costet P, Cvijic ME, Zhao L, Ebert C, Liu L, Gunawardhana K, Gordon D, Chang CP, Arnold JR, Yates T, Kelly D, Hogrefe K, Dawson D, Greenwood J, Ng LL, Singh A, McCann GP. Impact of diabetes on remodelling, microvascular function and exercise capacity in aortic stenosis. Open Heart 2023; 10:e002441. [PMID: 37586847 PMCID: PMC10432628 DOI: 10.1136/openhrt-2023-002441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE To characterise cardiac remodelling, exercise capacity and fibroinflammatory biomarkers in patients with aortic stenosis (AS) with and without diabetes, and assess the impact of diabetes on outcomes. METHODS Patients with moderate or severe AS with and without diabetes underwent echocardiography, stress cardiovascular magnetic resonance (CMR), cardiopulmonary exercise testing and plasma biomarker analysis. Primary endpoint for survival analysis was a composite of cardiovascular mortality, myocardial infarction, hospitalisation with heart failure, syncope or arrhythmia. Secondary endpoint was all-cause death. RESULTS Diabetes (n=56) and non-diabetes groups (n=198) were well matched for age, sex, ethnicity, blood pressure and severity of AS. The diabetes group had higher body mass index, lower estimated glomerular filtration rate and higher rates of hypertension, hyperlipidaemia and symptoms of AS. Biventricular volumes and systolic function were similar, but the diabetes group had higher extracellular volume fraction (25.9%±3.1% vs 24.8%±2.4%, p=0.020), lower myocardial perfusion reserve (2.02±0.75 vs 2.34±0.68, p=0.046) and lower percentage predicted peak oxygen consumption (68%±21% vs 77%±17%, p=0.002) compared with the non-diabetes group. Higher levels of renin (log10renin: 3.27±0.59 vs 2.82±0.69 pg/mL, p<0.001) were found in diabetes. Multivariable Cox regression analysis showed diabetes was not associated with cardiovascular outcomes, but was independently associated with all-cause mortality (HR 2.04, 95% CI 1.05 to 4.00; p=0.037). CONCLUSIONS In patients with moderate-to-severe AS, diabetes is associated with reduced exercise capacity, increased diffuse myocardial fibrosis and microvascular dysfunction, but not cardiovascular events despite a small increase in mortality.
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Affiliation(s)
- Abhishek Dattani
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Emer M Brady
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Aseel Alfuhied
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Christopher D Steadman
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Department of Cardiology, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Jian L Yeo
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Saadia Aslam
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Marko Banovic
- Cardiology Department, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Hui Xue
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter Kellman
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - Lei Zhao
- Bristol Myers Squibb Co, Princeton, New Jersey, USA
| | | | - Laura Liu
- Bristol Myers Squibb Co, Princeton, New Jersey, USA
| | | | - David Gordon
- Bristol Myers Squibb Co, Princeton, New Jersey, USA
| | | | - J Ranjit Arnold
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Damian Kelly
- Cardiology Department, Royal Derby Hospital, Derby, UK
| | - Kai Hogrefe
- Cardiology Department, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Dana Dawson
- Cardiovascular Medicine Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Greenwood
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Leong L Ng
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Anvesha Singh
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
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17
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Bilak JM, Yeo JL, Gulsin GS, Marsh AM, Sian M, Dattani A, Ayton SL, Parke KS, Bain M, Pang W, Boulos S, Pierre TGS, Davies MJ, Yates T, McCann GP, Brady EM. Impact of the Remission of Type 2 Diabetes on Cardiovascular Structure and Function, Exercise Capacity and Risk Profile: A Propensity Matched Analysis. J Cardiovasc Dev Dis 2023; 10:191. [PMID: 37233158 PMCID: PMC10219263 DOI: 10.3390/jcdd10050191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Type 2 diabetes (T2D) confers a high risk of heart failure frequently with evidence of cardiovascular structural and functional abnormalities before symptom onset. The effects of remission of T2D on cardiovascular structure and function are unknown. The impact of the remission of T2D, beyond weight loss and glycaemia, on cardiovascular structure and function and exercise capacity is described. Adults with T2D without cardiovascular disease underwent multimodality cardiovascular imaging, cardiopulmonary exercise testing and cardiometabolic profiling. T2D remission cases (Glycated hemoglobin (HbA1c) < 6.5% without glucose-lowering therapy, ≥3 months) were propensity score matched 1:4 based on age, sex, ethnicity and time of exposure to those with active T2D (n = 100) with the nearest-neighbour method and 1:1 with non-T2D controls (n = 25). T2D remission was associated with a lower leptin-adiponectin ratio, hepatic steatosis and triglycerides, a trend towards greater exercise capacity and significantly lower minute ventilation/carbon dioxide production (VE/VCO2 slope) vs. active T2D (27.74 ± 3.95 vs. 30.52 ± 5.46, p < 0.0025). Evidence of concentric remodeling remained in T2D remission vs. controls (left ventricular mass/volume ratio 0.88 ± 0.10 vs. 0.80 ± 0.10, p < 0.025). T2D remission is associated with an improved metabolic risk profile and ventilatory response to exercise without concomitant improvements in cardiovascular structure or function. There is a requirement for continued attention to risk factor control for this important patient population.
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Affiliation(s)
- Joanna M. Bilak
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Jian L. Yeo
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Gaurav S. Gulsin
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Anna-Marie Marsh
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Manjit Sian
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Abhishek Dattani
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Sarah L. Ayton
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Kelly S. Parke
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Moira Bain
- Public and Patient Involvement Representative for National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK
| | - Wenjie Pang
- Resonance Health Ltd., Burswood, WA 6100, Australia
| | | | - Tim G. St Pierre
- School of Physics, The University of Western Australia, Perth, WA 6009, Australia
| | - Melanie J. Davies
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (M.J.D.)
| | - Thomas Yates
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (M.J.D.)
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Emer M. Brady
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
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18
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Jayedi A, Zeraattalab-Motlagh S, Shahinfar H, Gregg EW, Shab-Bidar S. Effect of calorie restriction in comparison to usual diet or usual care on remission of type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2023; 117:870-882. [PMID: 36972801 DOI: 10.1016/j.ajcnut.2023.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 03/07/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Limited evidence is available about the dose-dependent effects of calorie restriction in patients with type 2 diabetes. OBJECTIVE To gather available evidence on the effect of calorie restriction on management of type 2 diabetes. METHODS We systematically searched PubMed, Scopus, CENTRAL, Web of Science, and gray literature to November 2022 for randomized trials longer than 12 weeks looking at the effect of a pre-specified calorie-restricted diet on remission of type 2 diabetes. We performed random-effects meta-analyses to estimate the absolute effect (risk difference) at 6-month (6±3 months) and 12-month (12±3 months) follow-ups. We performed dose-response meta-analyses to estimate mean difference (MD) for the effects of calorie restriction on cardiometabolic outcomes. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to judge the certainty of evidence. RESULTS 28 randomized trials with 6281 participants were included. Using a remission definition of glycated hemoglobin (HbA1c) <6.5% without antidiabetic medication use, calorie-restricted diets increased remission by 38 more per 100 patients (95%CI: 9 more, 67 more; n=5 trials, GRADE=moderate) at 6-month, and by 13 more per 100 patients (95%CI: 10 more, 18 more; n=4, GRADE=moderate) at 12-month in comparison to usual diet or usual care. Using a definition of HbA1c<6.5% after at least two months cessation of antidiabetic medications, remission increased by 34 more per 100 patients (95%CI: 15 more, 53 more; n=1, GRADE=very low) at 6-month and by 16 more per 100 patients (95%CI: 4 more, 49 more; n=2, GRADE=low) at 12-month. At 6-month, each 500 kcal/day decrease in energy intake resulted in clinically meaningful reductions in body weight (MD: -6.33 kg, 95%CI: -7.76, -4.90; n=22; GRADE=high) and HbA1c (MD: -0.82%, 95%CI: -1.05, -0.59; n=18, GRADE=high), which attenuated remarkably at 12-month. CONCLUSIONS Calorie-restricted diets may be effective interventions for type 2 diabetes remission, especially when coupled with an intensive lifestyle modification program. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42022300875).
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Affiliation(s)
- Ahmad Jayedi
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sheida Zeraattalab-Motlagh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Shahinfar
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Edward W Gregg
- School of Public Health, Imperial College London, United Kingdom
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
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19
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Petronilho A, Gois MDO, Sakaguchi C, Frade MCM, Roscani MG, Catai AM. Effects of Physical Exercise on Left Ventricular Function in Type 2 Diabetes Mellitus: A Systematic Review. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2023. [DOI: 10.36660/ijcs.20220020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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20
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Dhungana RR, Pedisic Z, de Courten M. Implementation of non-pharmacological interventions for the treatment of hypertension in primary care: a narrative review of effectiveness, cost-effectiveness, barriers, and facilitators. BMC PRIMARY CARE 2022; 23:298. [PMID: 36418958 PMCID: PMC9686020 DOI: 10.1186/s12875-022-01884-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The current guidelines for the prevention, detection, evaluation, and management of hypertension recommend six types of non-pharmacological interventions: alcohol reduction, salt intake reduction, increased potassium intake, physical activity, weight loss, and heart-healthy diets. However, the non-pharmacological interventions are still not widely used in primary care. In this paper, we, therefore, reviewed and summarised the evidence on the effectiveness, cost-effectiveness, barriers, and facilitators of non-pharmacological interventions for the treatment of hypertension in primary care. METHODS A thorough literature search was conducted in Embase, Google Scholar, and PubMed databases, to identify the most recent reviews or, in their absence, primary studies on alcohol reduction, salt intake reduction, potassium supplementation, physical activity, weight reduction, heart-healthy diets, and other non-pharmacological interventions for the treatment of hypertension in primary care. RESULTS Alcohol reduction is a non-pharmacological intervention for the treatment of hypertension in primary care with proven effectiveness, feasibility, and acceptability. Interventions for sodium intake reduction, physical activity, and weight reduction are effective but there is insufficient evidence regarding their feasibility and acceptability in primary care settings. Evidence on the effectiveness of potassium intake and heart-healthy diets is limited and inconsistent. There is a lack of evidence on the cost-effectiveness of non-pharmacological interventions in the treatment of hypertension. The most common barriers to deliver such interventions related to healthcare providers include a lack of time, knowledge, self-confidence, resources, clear guidelines, and financial incentives. The most common barriers related to patients include a lack of motivation and educational resources. Less evidence is available on facilitators of implementing non-pharmacological interventions in primary care. Besides, facilitators differed by different types of interventions. CONCLUSIONS Available evidence suggests that more pragmatic, clinically feasible, and logistically simple interventions are required for sodium intake reduction, physical activity, and weight reduction in primary care settings. Future studies should provide further evidence on the effectiveness of weight control, potassium intake, and heart-healthy diets. More research is also needed on cost-effectiveness and facilitators of all types of effective non-pharmacological interventions for the treatment of hypertension in primary care.
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Affiliation(s)
- Raja Ram Dhungana
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Zeljko Pedisic
- Institute for Health and Sport, Victoria University, Melbourne, Australia
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21
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Yates T, Sargeant JA, King JA, Henson J, Edwardson CL, Redman E, Gulsin GS, Brady EM, Ahmad E, Stensel DJ, Webb DR, McCann GP, Khunti K, Davies MJ. Initiation of New Glucose-Lowering Therapies May Act to Reduce Physical Activity Levels: Pooled Analysis From Three Randomized Trials. Diabetes Care 2022; 45:2749-2752. [PMID: 35984425 DOI: 10.2337/dc22-0888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/26/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA) reduce body weight and improve cardiometabolic health, but their effect on physical activity is unknown. RESEARCH DESIGN AND METHODS We pooled data (n = 148) from three randomized trials to investigate the effect of empagliflozin (SGLT2i) and liraglutide (GLP-1RA), in comparison with sitagliptin (dipeptidyl peptidase 4 inhibitor) and dietary therapies, on accelerometer-assessed physical activity. RESULTS Liraglutide (mean -1,144 steps/day; 95% CI -2,069 to -220), empagliflozin (-1,132 steps/day; -1,739, -524), and sitagliptin (-852 steps/day; -1,625, -78) resulted in reduced total daily physical activity after 6 months (P < 0.01 vs. control). Moderate- to vigorous-intensity physical activity was also reduced. Dietary interventions led to no change or an increase in physical activity. CONCLUSIONS The initiation of all glucose-lowering therapies was associated with reduced physical activity, warranting further investigation.
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Affiliation(s)
- Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
| | - Jack A Sargeant
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, U.K
| | - James A King
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, U.K
| | - Joe Henson
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
| | - Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
| | - Emma Redman
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, U.K
| | - Gaurav S Gulsin
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
- Department of Cardiovascular Sciences, University of Leicester, Leicester, U.K
| | - Emer M Brady
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
- Department of Cardiovascular Sciences, University of Leicester, Leicester, U.K
| | - Ehtasham Ahmad
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
| | - David J Stensel
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, U.K
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - David R Webb
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
| | - Gerry P McCann
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
- Department of Cardiovascular Sciences, University of Leicester, Leicester, U.K
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- NIHR Applied Research Collaboration East Midlands, Leicester, U.K
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
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22
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Li K, Song H, Wei F, Liu D, Zhao Y, Yin H, Cui Y, Zhang H, Liu Z. High salt intake damages myocardial viability and induces cardiac remodeling via chronic inflammation in the elderly. Front Cardiovasc Med 2022; 9:952691. [PMID: 36277781 PMCID: PMC9582749 DOI: 10.3389/fcvm.2022.952691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background The heart is an important target organ for the harmful effects of high dietary salt intake. However, the effects and associations of high salt intake on myocardial viability, cardiac function changes, and myocardial remodeling are unclear. Methods A total of 3,810 participants aged 60 years and older were eligible and enrolled from April 2008 to November 2010 and from August 2019 to November 2019 in the Shandong area of China. Salt intake was estimated using 24-h urine collection consecutively for 7 days. Myocardial strain rates, cardiac function and structure, and serum high-sensitivity C-reactive protein (hsCRP) levels were assessed. Participants were classified into low (n = 643), mild (n = 989), moderate (n = 1,245), and high (n = 933) groups, corresponding to < 6, 6–9, 9–12, and >12 g/day of salt intake, respectively, depending on the salt intake estimation. Results The global early diastolic strain rate (SRe) and late diastolic strain rate (SRa) in the high group were 1.58 ± 0.26, 1.38 ± 0.24. respectively, and significantly lower compared with the low, mild, and moderate groups (all P < 0.05). The global systolic strain rate (SRs) in the high group was −1.24 ± 0.24, and it was higher than those in the low, mild, and moderate groups (all P < 0.05). Salt intake was independently and positively correlated with global SRs, Tei index, and the parameters of left ventricular structure separately; negatively correlated with global SRe and SRa, left ventricular short axis shortening rate, left ventricular ejection fraction after adjusting for confounders (all Padjusted < 0.001). Hayes process analyses demonstrated that the mediating effects of hsCRP on global SRe, SRa, and SRs; Tei index; and left ventricular remodeling index were −0.013 (95% CI: −0.015 to −0.010), −0.010 (−0.012 to −0.008), 0.008 (0.006–0.010), 0.005 (0.003–0.006), and 0.010 (0.009–0.012), respectively (all Padjusted < 0.001). Conclusion Our data indicate that excess salt intake is independently associated with the impairment in myocardial viability and cardiac function, as well as myocardial remodeling. Chronic inflammation might play a mediating role in the association between high salt intake and cardiac function damage and myocardial remodeling.
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Affiliation(s)
- Ke Li
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China,School of Clinical and Basic Medical Sciences, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, China
| | - Huajing Song
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China,School of Clinical and Basic Medical Sciences, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, China
| | - Fang Wei
- Department of Cardiology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Di Liu
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China,School of Clinical and Basic Medical Sciences, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, China
| | - Yingxin Zhao
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China,School of Clinical and Basic Medical Sciences, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, China
| | - Haipeng Yin
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China,School of Clinical and Basic Medical Sciences, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, China
| | - Yi Cui
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Hua Zhang
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China,School of Clinical and Basic Medical Sciences, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, China,*Correspondence: Hua Zhang
| | - Zhendong Liu
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China,School of Clinical and Basic Medical Sciences, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, China,Zhendong Liu
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23
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Dasgupta K, Boulé N, Henson J, Chevalier S, Redman E, Chan D, McCarthy M, Champagne J, Arsenyadis F, Rees J, Da Costa D, Gregg E, Yeung R, Hadjiconstantinou M, Dattani A, Friedrich MG, Khunti K, Rahme E, Fortier I, Prado CM, Sherman M, Thompson RB, Davies MJ, McCann GP, Yates T. Remission of type 2 diabetes and improved diastolic function by combining structured exercise with meal replacement and food reintroduction among young adults: the RESET for REMISSION randomised controlled trial protocol. BMJ Open 2022; 12:e063888. [PMID: 36130753 PMCID: PMC9494595 DOI: 10.1136/bmjopen-2022-063888] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) onset before 40 years of age has a magnified lifetime risk of cardiovascular disease. Diastolic dysfunction is its earliest cardiac manifestation. Low energy diets incorporating meal replacement products can induce diabetes remission, but do not lead to improved diastolic function, unlike supervised exercise interventions. We are examining the impact of a combined low energy diet and supervised exercise intervention on T2DM remission, with peak early diastolic strain rate, a sensitive MRI-based measure, as a key secondary outcome. METHODS AND ANALYSIS This prospective, randomised, two-arm, open-label, blinded-endpoint efficacy trial is being conducted in Montreal, Edmonton and Leicester. We are enrolling 100 persons 18-45 years of age within 6 years' T2DM diagnosis, not on insulin therapy, and with obesity. During the intensive phase (12 weeks), active intervention participants adopt an 800-900 kcal/day low energy diet combining meal replacement products with some food, and receive supervised exercise training (aerobic and resistance), three times weekly. The maintenance phase (12 weeks) focuses on sustaining any weight loss and exercise practices achieved during the intensive phase; products and exercise supervision are tapered but reinstituted, as applicable, with weight regain and/or exercise reduction. The control arm receives standard care. The primary outcome is T2DM remission, (haemoglobin A1c of less than 6.5% at 24 weeks, without use of glucose-lowering medications during maintenance). Analysis of remission will be by intention to treat with stratified Fisher's exact test statistics. ETHICS AND DISSEMINATION The trial is approved in Leicester (East Midlands - Nottingham Research Ethics Committee (21/EM/0026)), Montreal (McGill University Health Centre Research Ethics Board (RESET for remission/2021-7148)) and Edmonton (University of Alberta Health Research Ethics Board (Pro00101088). Findings will be shared widely (publications, presentations, press releases, social media platforms) and will inform an effectiveness trial. TRIAL REGISTRATION NUMBER ISRCTN15487120.
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Affiliation(s)
- Kaberi Dasgupta
- Department of Medicine, McGill University and Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Normand Boulé
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Joseph Henson
- Diabetes Research Centre, University of Leicester and NIHR Leicester Biomedical Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Emma Redman
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust and NIHR Leicester Biomedical Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Deborah Chan
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Matthew McCarthy
- Diabetes Research Centre, University of Leicester and NIHR Leicester Biomedical Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Julia Champagne
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Frank Arsenyadis
- Diabetes Research Centre, University of Leicester and NIHR Leicester Biomedical Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Jordan Rees
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Deborah Da Costa
- Department of Medicine, McGill University and Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Edward Gregg
- School of Public Health, Imperial College London, London, UK
| | - Roseanne Yeung
- Division of Endocrinology & Metabolism, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Hadjiconstantinou
- Diabetes Research Centre, University of Leicester and NIHR Leicester Biomedical Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Abhishek Dattani
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Matthias G Friedrich
- Courtois Cardiovascular Signature Centre, McGill University Health Centre and Departments of Medicine and Diagnostic Radiology, McGill University, Montreal, Quebec, Canada
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester and NIHR Applied Research Collaboration - East Midlands (ARC-EM), University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Elham Rahme
- Department of Medicine, McGill University and Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Isabel Fortier
- Department of Medicine, McGill University and Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Mark Sherman
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Richard B Thompson
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester and NIHR Leicester Biomedical Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester and NIHR Leicester Biomedical Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
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Alfuhied A, Gulsin GS, Athithan L, Brady EM, Parke K, Henson J, Redman E, Marsh AM, Yates T, Davies MJ, McCann GP, Singh A. The impact of lifestyle intervention on left atrial function in type 2 diabetes: results from the DIASTOLIC study. Int J Cardiovasc Imaging 2022; 38:2013-2023. [PMID: 35233724 PMCID: PMC10247829 DOI: 10.1007/s10554-022-02578-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 02/21/2022] [Indexed: 11/05/2022]
Abstract
Aerobic exercise training and low energy diets have been shown to improve left ventricular remodelling and diastolic function in adults with type 2 diabetes (T2D), albeit with differential effects. The impact of these lifestyle interventions on left atrial (LA) function, however, has not previously been reported. The DIASTOLIC study was a prospective, randomised, open-label, blind endpoint trial, in which 90 people with obesity and T2D and no prevalent cardiovascular disease were randomised to a 12-week intervention of: (i) routine care, (ii) aerobic exercise training, or (iii) low energy (≈ 810 kcal/day) meal replacement plan (MRP). Cardiac magnetic resonance (CMR) imaging was performed pre- and post-intervention. Image analysis included LA volumes (LAV), emptying fraction (LAEF), and LA strain (LAS) corresponding to LA reservoir (LAS-r), conduit (LAS-cd), and booster pump (LAS-bp) function. 73 participants with T2D (mean age 50 ± 6 years, 62% male, body mass index (BMI) 36.1 ± 5.3 kg/m2) completed the trial and had analysable LA images. There was no significant change in CMR measured LA volumetric function (LAV/LAEF) in any group. The routine care group showed no significant change in BMI or LAS. In the MRP group, there were significant reductions in BMI (4.5 kg/m2) and a significant increase in LAS-r and LAS-bp (29.9 ± 7.0 to 32.3 ± 7.0%, p = 0.036 and 14.6 ± 5.3 to 17.2 ± 3.7%, p = 0.034). The exercise group showed a small reduction in BMI (0.49 kg/m2), with no significant change in LAS. Compared to routine care, weight loss via a 12-week MRP, led to improvements in LA filling and contractile function in adults with T2D and obesity. However, these within-group changes were not statistically significant on between-group comparison. ClinicalTrials.gov Identifier: NCT02590822.
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Affiliation(s)
- Aseel Alfuhied
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Gaurav S. Gulsin
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
| | - Lavanya Athithan
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
| | - Emer M. Brady
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
| | - Kelly Parke
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
| | - Joseph Henson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Emma Redman
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Anna-Marie Marsh
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
| | - Thomas Yates
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Melanie J. Davies
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
| | - Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
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25
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Jayedi A, Emadi A, Shab-Bidar S. Dose-Dependent Effect of Supervised Aerobic Exercise on HbA 1c in Patients with Type 2 Diabetes: A Meta-analysis of Randomized Controlled Trials. Sports Med 2022; 52:1919-1938. [PMID: 35362859 DOI: 10.1007/s40279-022-01673-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Previous meta-analyses indicated that aerobic exercise can improve glycemic control. However, the optimum dose of exercise is still being discussed. OBJECTIVE The aim of this study was to examine the dose-dependent effect of supervised aerobic training (SAT) on glycated hemoglobin (HbA1c). METHODS We searched PubMed, Scopus, and Web of Science to May 2021 for randomized trials with an intervention period of 12 weeks or longer evaluating the effect of SAT on HbA1c in adults with type 2 diabetes mellitus. Secondary outcomes included quality of life, change in hypoglycemic medications, and adverse events. A random-effects dose-response meta-analysis was conducted. RESULTS The analysis of 26 trials with 1253 participants indicated that each 30-min/week SAT reduced HbA1c by - 0.22 percentage point (95% CI - 0.29 to - 0.15; GRADE = strong). Levels of HbA1c decreased proportionally with the increase in the duration of moderate to vigorous-intensity SAT to 100 min/week (mean difference100 min/week: - 0.96 percentage point, 95% CI - 1.25 to - 0.67), with flattening of the curve at higher duration. Aerobic exercise decreased antidiabetic medications by 13 per 100 patients (risk difference 0.13, 95% CI 0.02-0.23; 7 trials, n = 375; GRADE = moderate), and increased hypoglycemic reactions by 10 per 100 patients (risk difference: 0.10, 95% CI 0.03-0.17; 4 trials, n = 263; GRADE = low) and adverse events by 4 per 100 patients (risk difference: 0.04, 95% CI - 0.02 to 0.11; 2 trials, n = 236; GRADE = low). Limited evidence is available for quality of life. CONCLUSIONS Every 30 min/week of moderate to vigorous aerobic exercise can exert a significant effect on HbA1c, with the highest effect observed from 100 min/week and above. However, exercise durations above 100 min/week seem ineffective for further reductions. PROTOCOL REGISTRATION PROSPERO (CRD42021257251).
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Affiliation(s)
- Ahmad Jayedi
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran.,Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P. O. Box 14155/6117, Tehran, Iran
| | - Alireza Emadi
- Food Safety Research Center (Salt), Semnan University of Medical Sciences, Semnan, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P. O. Box 14155/6117, Tehran, Iran.
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26
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Brady EM, Gulsin GS, Mirkes EM, Parke K, Kanagala P, Ng LL, Graham‐Brown MPM, Athithan L, Henson J, Redman E, Yang J, Zhao L, Argyridou S, Gray LJ, Yates T, Davies MJ, McCann GP. Fibro-inflammatory recovery and type 2 diabetes remission following a low calorie diet but not exercise training: A secondary analysis of the DIASTOLIC randomised controlled trial. Diabet Med 2022; 39:e14884. [PMID: 35587779 PMCID: PMC9543965 DOI: 10.1111/dme.14884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 05/08/2022] [Indexed: 12/15/2022]
Abstract
AIMS To investigate the relationship between fibro-inflammatory biomarkers and cardiovascular structure/function in people with Type 2 Diabetes (T2D) compared to healthy controls and the effect of two lifestyle interventions in T2D. METHODS Data were derived from the DIASTOLIC randomised controlled trial (RCT) and includes a comparison between those with T2D and the matched healthy volunteers recruited at baseline. Adults with T2D without cardiovascular disease (CVD) were randomized to a 12-week intervention either: (1) exercise training, (2) a low-energy (∼810 kcal/day) meal-replacement plan (MRP) or (3) standard care. Principal Component and Fisher's linear discriminant analysis were used to investigate the relationships between MRI acquired cardiovascular outcomes and fibro-inflammatory biomarkers in cases versus controls and pre- and post-intervention in T2D. RESULTS At baseline, 83 people with T2D (mean age 50.5 ± 6.4; 58% male) and 36 healthy controls (mean age 48.6 ± 6.2; 53% male) were compared and 76 people with T2D completed the RCT for pre- post-analysis. Compared to healthy controls, subjects with T2D had adverse cardiovascular remodelling and a fibro-inflammatory profile (20 differentially expressed biomarkers). The 3D data visualisations showed almost complete separation between healthy controls and those with T2D, and a marked shift towards healthy controls following the MRP (15 biomarkers significantly changed) but not exercise training. CONCLUSIONS Fibro-inflammatory pathways and cardiovascular structure/function are adversely altered before the onset of symptomatic CVD in middle-aged adults with T2D. The MRP improved the fibro-inflammatory profile of people with T2D towards a more healthy status. Long-term studies are required to assess whether these changes lead to continued reverse cardiac remodelling and prevent CVD.
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Affiliation(s)
- Emer M. Brady
- Department of Cardiovascular SciencesUniversity of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research CentreLeicesterUK
| | - Gaurav S. Gulsin
- Department of Cardiovascular SciencesUniversity of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research CentreLeicesterUK
| | - Evgeny M. Mirkes
- School of Mathematics and Actuarial ScienceUniversity of LeicesterLeicesterUK
| | - Kelly Parke
- Department of Cardiovascular SciencesUniversity of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research CentreLeicesterUK
| | - Prathap Kanagala
- University of LiverpoolLiverpool Centre for Cardiovascular ScienceLiverpoolUK
| | - Leong L. Ng
- Department of Cardiovascular SciencesUniversity of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research CentreLeicesterUK
| | - Matthew P. M. Graham‐Brown
- Department of Cardiovascular SciencesUniversity of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research CentreLeicesterUK
| | - Lavanya Athithan
- Department of Cardiovascular SciencesUniversity of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research CentreLeicesterUK
| | - Joseph Henson
- Diabetes Research CentreNIHR Leicester Biomedical Research CentreLeicesterUK
| | - Emma Redman
- Diabetes Research CentreNIHR Leicester Biomedical Research CentreLeicesterUK
- University Hospitals of Leicester NHS TrustLeicesterUK
| | - Jang Yang
- Cardiovascular & Fibrosis Translational ResearchBristolNew JerseyUSA
| | - Lei Zhao
- Cardiovascular & Fibrosis Translational ResearchBristolNew JerseyUSA
| | - Stavroula Argyridou
- Diabetes Research CentreNIHR Leicester Biomedical Research CentreLeicesterUK
| | - Laura J. Gray
- Department of Health SciencesUniversity of LeicesterLeicesterUK
| | - Thomas Yates
- Diabetes Research CentreNIHR Leicester Biomedical Research CentreLeicesterUK
| | - Melanie J. Davies
- Diabetes Research CentreNIHR Leicester Biomedical Research CentreLeicesterUK
- University Hospitals of Leicester NHS TrustLeicesterUK
| | - Gerry P. McCann
- Department of Cardiovascular SciencesUniversity of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research CentreLeicesterUK
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27
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Yeo JL, Gulsin GS, Brady EM, Dattani A, Bilak JM, Marsh AM, Sian M, Athithan L, Parke KS, Wormleighton J, Graham-Brown MPM, Singh A, Arnold JR, Lawson C, Davies MJ, Xue H, Kellman P, McCann GP. Association of ambulatory blood pressure with coronary microvascular and cardiac dysfunction in asymptomatic type 2 diabetes. Cardiovasc Diabetol 2022; 21:85. [PMID: 35643571 PMCID: PMC9148453 DOI: 10.1186/s12933-022-01528-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/20/2022] [Indexed: 02/07/2023] Open
Abstract
Background Type 2 diabetes (T2D) and hypertension commonly coexist and are associated with subclinical myocardial structural and functional changes. We sought to determine the association between blood pressure (BP) and left ventricular (LV) remodeling, systolic/diastolic function, and coronary microvascular function, among individuals with T2D without prevalent cardiovascular disease. Methods Participants with T2D and age-, sex-, and ethnicity-matched controls underwent comprehensive cardiovascular phenotyping including fasting bloods, transthoracic echocardiography, cardiovascular magnetic resonance imaging with quantitative adenosine stress/rest perfusion, and office and 24-h ambulatory BP monitoring. Multivariable linear regression was performed to determine independent associations between BP and imaging markers of remodeling and function in T2D. Results Individuals with T2D (n = 205, mean age 63 ± 7 years) and controls (n = 40, mean age 61 ± 8 years) were recruited. Mean 24-h systolic BP, but not office BP, was significantly greater among those with T2D compared to controls (128.8 ± 11.7 vs 123.0 ± 13.1 mmHg, p = 0.006). Those with T2D had concentric LV remodeling (mass/volume 0.91 ± 0.15 vs 0.82 ± 0.11 g/mL, p < 0.001), decreased myocardial perfusion reserve (2.82 ± 0.83 vs 3.18 ± 0.82, p = 0.020), systolic dysfunction (global longitudinal strain 16.0 ± 2.3 vs 17.2 ± 2.1%, p = 0.004) and diastolic dysfunction (E/e’ 9.30 ± 2.43 vs 8.47 ± 1.53, p = 0.044) compared to controls. In multivariable regression models adjusted for 14 clinical variables, mean 24-h systolic BP was independently associated with concentric LV remodeling (β = 0.165, p = 0.031), diastolic dysfunction (β = 0.273, p < 0.001) and myocardial perfusion reserve (β = − 0.218, p = 0.016). Mean 24-h diastolic BP was associated with LV concentric remodeling (β = 0.201, p = 0.016). Conclusion 24-h ambulatory systolic BP, but not office BP, is independently associated with cardiac remodeling, coronary microvascular dysfunction, and diastolic dysfunction among asymptomatic individuals with T2D. (Clinical trial registration. URL: https://clinicaltrials.gov/ct2/show/NCT03132129 Unique identifier: NCT03132129). Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01528-2.
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28
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Barker MM, Zaccardi F, Brady EM, Gulsin GS, Hall AP, Henson J, Htike ZZ, Khunti K, McCann GP, Redman EL, Webb DR, Wilmot EG, Yates T, Yeo J, Davies MJ, Sargeant JA. Age at diagnosis of type 2 diabetes and cardiovascular risk factor profile: A pooled analysis. World J Diabetes 2022; 13:260-271. [PMID: 35432761 PMCID: PMC8984563 DOI: 10.4239/wjd.v13.i3.260] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/08/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The diagnosis of type 2 diabetes (T2D) in younger adults, an increasingly common public health issue, is associated with a higher risk of cardiovascular complications and mortality, which may be due to a more adverse cardiovascular risk profile in individuals diagnosed at a younger age.
AIM To investigate the association between age at diagnosis and the cardiovascular risk profile in adults with T2D.
METHODS A pooled dataset was used, comprised of data from five previous studies of adults with T2D, including 1409 participants of whom 196 were diagnosed with T2D under the age of 40 years. Anthropometric and blood biomarker measurements included body weight, body mass index (BMI), waist circumference, body fat percentage, glycaemic control (HbA1c), lipid profile and blood pressure. Univariable and multivariable linear regression models, adjusted for diabetes duration, sex, ethnicity and smoking status, were used to investigate the association between age at diagnosis and each cardiovascular risk factor.
RESULTS A higher proportion of participants diagnosed with T2D under the age of 40 were female, current smokers and treated with glucose-lowering medications, compared to participants diagnosed later in life. Participants diagnosed with T2D under the age of 40 also had higher body weight, BMI, waist circumference and body fat percentage, in addition to a more adverse lipid profile, compared to participants diagnosed at an older age. Modelling results showed that each one year reduction in age at diagnosis was significantly associated with 0.67 kg higher body weight [95% confidence interval (CI): 0.52-0.82 kg], 0.18 kg/m2 higher BMI (95%CI: 0.10-0.25) and 0.32 cm higher waist circumference (95%CI: 0.14-0.49), after adjustment for duration of diabetes and other confounders. Younger age at diagnosis was also significantly associated with higher HbA1c, total cholesterol, low-density lipoprotein cholesterol and triglycerides.
CONCLUSION The diagnosis of T2D earlier in life is associated with a worse cardiovascular risk factor profile, compared to those diagnosed later in life.
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Affiliation(s)
- Mary M Barker
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Francesco Zaccardi
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Emer M Brady
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, Leicester LE3 9QP, United Kingdom
| | - Andrew P Hall
- The Hanning Sleep Laboratory, University Hospitals of Leicester NHS Trust, University of Leicester, Leicester LE5 4PW, United Kingdom
| | - Joseph Henson
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE5 4PW, United Kingdom
| | - Zin Zin Htike
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, United Kingdom
- National Institute for Health Research, Applied Research Collaboration East Midlands, Leicester LE5 4PW, United Kingdom
| | - Gerald P McCann
- Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, Leicester LE3 9QP, United Kingdom
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE5 4PW, United Kingdom
| | - Emma L Redman
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE5 4PW, United Kingdom
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, United Kingdom
| | - David R Webb
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE5 4PW, United Kingdom
| | - Emma G Wilmot
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
- Department of Diabetes, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, United Kingdom
| | - Tom Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE5 4PW, United Kingdom
| | - Jian Yeo
- Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, Leicester LE3 9QP, United Kingdom
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE5 4PW, United Kingdom
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, United Kingdom
| | - Jack A Sargeant
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE5 4PW, United Kingdom
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29
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Shen LT, Jiang L, Zhu YW, Shen MT, Huang S, Shi R, Li Y, Yang ZG. Additive effect of aortic regurgitation degree on left ventricular strain in patients with type 2 diabetes mellitus evaluated via cardiac magnetic resonance tissue tracking. Cardiovasc Diabetol 2022; 21:37. [PMID: 35277181 PMCID: PMC8917654 DOI: 10.1186/s12933-022-01471-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/28/2022] [Indexed: 11/22/2022] Open
Abstract
Background Type 2 diabetes mellitus causes left ventricular (LV) remodeling and increases the risk of aortic regurgitation (AR), which causes further heart damage. This study aimed to investigate whether AR aggravates LV deformation dysfunction and to identify independent factors affecting the global peak strain (PS) of LV remodeling in patients with type 2 diabetes mellitus (T2DM) who presented with AR and those without T2DM. Methods In total, 215 patients with T2DM and 83 age- and sex-matched healthy controls who underwent cardiac magnetic resonance examination were included. Based on the echocardiogram findings, T2DM patients with AR were divided into three groups (mild AR [n = 28], moderate AR [n = 21], and severe AR [n = 17]). LV function and global strain parameters were compared, and multivariate analysis was performed to identify the independent indicators of LV PS. Results The T2DM patients with AR had a lower LV global PS, peak systolic strain rate (PSSR), and peak diastolic strain rate (PDSR) in three directions than those without AR and non-T2DM controls. Patients without AR had a lower PS (radial and longitudinal) and PDSR in three directions and higher PSSR (radial and longitudinal) than healthy controls. Further, regurgitation degree was an independent factor of LV global radial, circumferential, and longitudinal PS. Conclusion AR may aggravate LV stiffness in patients with T2DM, resulting in lower LV strain and function. Regurgitation degree and sex were independently correlated with LV global PS in patients with T2DM and AR. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01471-2.
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30
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Liao L, Shi B, Ding Z, Chen L, Dong F, Li J, Zhong Y, Xu J. Echocardiographic study of myocardial work in patients with type 2 diabetes mellitus. BMC Cardiovasc Disord 2022; 22:59. [PMID: 35172745 PMCID: PMC8851829 DOI: 10.1186/s12872-022-02482-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background A noninvasive left ventricular (LV) pressure-strain loop (PSL) provides a new method to quantify myocardial work (MW) by combining global longitudinal strain (GLS) and LV pressure, which exerts potential advantages over traditional GLS. We studied the LV PSL and MW in patients with type 2 diabetes mellitus (T2DM). Methods This cross-sectional study included 201 subjects (54 healthy controls and 147 T2DM patients) who underwent complete two-dimensional echocardiography (2DE), including 2D speckle-tracking echocardiography (STE), as well as brachial artery pulse pressure measurement. The PSL was used to determine the global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) of all study participants. The association between T2DM and LV function was evaluated according to these MW indices. Results The GLS was significantly lower in the T2DM group than in the control group (P < 0.001), indicating that the LV myocardium had been damaged, although the LV ejection fraction (LVEF) was still normal. The GWI and GWE were decreased (P = 0.022) and the GWW was increased (P < 0.001) in diabetic patients compared with controls, but the GCW was comparable in the two groups (P = 0.160). In all diabetic patients, age, body mass index, systolic blood pressure, smoking history, and LVEF were correlated with GWI, GWW and GWE. Conclusions The use of LV PSL is a novel noninvasive technique that could help to depict the relationship between LV myocardial damage and MW in patients with T2DM.
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Affiliation(s)
- Lisi Liao
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China.,Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Bobo Shi
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China.,Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Zhimin Ding
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China.,Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Lixin Chen
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China.,Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Fajin Dong
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China.,Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Jian Li
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China.,Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Yulin Zhong
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China.,Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Jinfeng Xu
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, 1017 Dongmen North Road, Luohu District, Shenzhen, 518020, Guangdong, China. .,Department of Ultrasound, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China.
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31
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Gene and metabolite expression dependence on body mass index in human myocardium. Sci Rep 2022; 12:1425. [PMID: 35082386 PMCID: PMC8791972 DOI: 10.1038/s41598-022-05562-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
We hypothesized that body mass index (BMI) dependent changes in myocardial gene expression and energy-related metabolites underlie the biphasic association between BMI and mortality (the obesity paradox) in cardiac surgery. We performed transcriptome profiling and measured a panel of 144 metabolites in 53 and 55, respectively, myocardial biopsies from a cohort of sixty-six adult patients undergoing coronary artery bypass grafting (registration: NCT02908009). The initial analysis identified 239 transcripts with biphasic BMI dependence. 120 displayed u-shape and 119 n-shape expression patterns. The identified local minima or maxima peaked at BMI 28–29. Based on these results and to best fit the WHO classification, we grouped the patients into three groups: BMI < 25, 25 ≤ BMI ≤ 32, and BMI > 32. The analysis indicated that protein translation-related pathways were downregulated in 25 ≤ BMI ≤ 32 compared with BMI < 25 patients. Muscle contraction transcripts were upregulated in 25 ≤ BMI ≤ 32 patients, and cholesterol synthesis and innate immunity transcripts were upregulated in the BMI > 32 group. Transcripts involved in translation, muscle contraction and lipid metabolism also formed distinct correlation networks with biphasic dependence on BMI. Metabolite analysis identified acylcarnitines and ribose-5-phosphate increasing in the BMI > 32 group and α-ketoglutarate increasing in the BMI < 25 group. Molecular differences in the myocardium mirror the biphasic relationship between BMI and mortality.
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32
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Bilak JM, Alam U, Miller CA, McCann GP, Arnold JR, Kanagala P. Microvascular Dysfunction in Heart Failure with Preserved Ejection Fraction: Pathophysiology, Assessment, Prevalence and Prognosis. Card Fail Rev 2022; 8:e24. [PMID: 35846985 PMCID: PMC9274364 DOI: 10.15420/cfr.2022.12] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/03/2022] [Indexed: 11/04/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) currently accounts for approximately half of all new heart failure cases in the community. HFpEF is closely associated with chronic lifestyle-related diseases, such as obesity and type 2 diabetes, and clinical outcomes are worse in those with than without comorbidities. HFpEF is pathophysiologically distinct from heart failure with reduced ejection fraction, which may explain, in part, the disparity of treatment options available between the two heart failure phenotypes. The mechanisms underlying HFpEF are complex, with coronary microvascular dysfunction (MVD) being proposed as a potential key driver in its pathophysiology. In this review, the authors highlight the evidence implicating MVD in HFpEF pathophysiology, the diagnostic approaches for identifying MVD (both invasive and non-invasive) and the prevalence and prognostic significance of MVD.
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Affiliation(s)
- Joanna M Bilak
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield HospitalLeicester, UK
| | - Uazman Alam
- Liverpool University Hospitals NHS Foundation TrustLiverpool, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Institute of Human Development, University of ManchesterManchester, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of LiverpoolLiverpool, UK
| | - Christopher A Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science CentreManchester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield HospitalLeicester, UK
| | - Jayanth R Arnold
- Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield HospitalLeicester, UK
| | - Prathap Kanagala
- Liverpool University Hospitals NHS Foundation TrustLiverpool, UK
- Liverpool Centre for Cardiovascular Sciences, Faculty of Health and Life SciencesLiverpool, UK
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33
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Impact of diabetes on cardiopulmonary function: the added value of a combined cardiopulmonary and echocardiography stress test. Heart Fail Rev 2021; 28:645-655. [PMID: 34820732 DOI: 10.1007/s10741-021-10194-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 12/25/2022]
Abstract
Type 2 diabetes mellitus (T2DM) represents a major health issue worldwide, as patients with T2DM show an excess risk of death for cardiovascular causes, twice as high as the general population. Among the many complications of T2DM, heart failure (HF) deserves special consideration as one of the leading causes of morbidity and reduced life expectancy. T2DM has been associated with different phenotypes of HF, including HF with reduced and preserved ejection fraction. Cardiopulmonary exercise testing (CPET) can evaluate the metabolic and ventilatory alterations related to myocardial dysfunction and/or peripheral impairment, representing a unique tool for the clinician to study the whole HF spectrum. While CPET allows for a thorough evaluation of functional capacity, it cannot directly differentiate central and peripheral determinants of effort intolerance. Combining CPET with imaging techniques could provide even higher accuracy and further insights into the progression of the disease since signs of left ventricular systolic and diastolic dysfunction can be detected during exercise, even in asymptomatic diabetic individuals. This review aims to dissect the alterations in cardiopulmonary function characterising patients with T2DM and HF to improve patient risk stratification.
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34
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Walters GWM, Redman E, Gulsin GS, Henson J, Argyridou S, Yates T, Davies MJ, Parke K, McCann GP, Brady EM. Interrelationship between micronutrients and cardiovascular structure and function in type 2 diabetes. J Nutr Sci 2021; 10:e88. [PMID: 34733500 PMCID: PMC8532075 DOI: 10.1017/jns.2021.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022] Open
Abstract
Micronutrients are important for normal cardiovascular function. They may play a role in the increased risk of cardiovascular disease observed in people with type 2 diabetes (T2D) and T2D-related heart failure. The aims of this study were to (1) examine micronutrient status in people with T2D v. healthy controls; (2) assess any changes following a nutritionally complete meal replacement plan (MRP) compared with routine care; (3) determine if any changes were associated with changes in cardiovascular structure/function. This was a secondary analysis of data from a prospective, randomised, open-label, blinded end-point trial of people with T2D, with a nested case-control [NCT02590822]. Anthropometrics, cardiac resonance imaging and fasting blood samples (to quantify vitamins B1, B6, B12, D and C; and iron and ferritin) were collected at baseline and 12 weeks following the MRP or routine care. Comparative data in healthy controls were collected at baseline. A total of eighty-three people with T2D and thirty-six healthy controls were compared at baseline; all had micronutrient status within reference ranges. Vitamin B1 was higher (148⋅9 v. 131⋅7; P 0⋅01) and B6 lower (37⋅3 v. 52⋅9; P 0⋅01) in T2D v. controls. All thirty participants randomised to routine care and twenty-four to the MRP completed the study. There was an increase in vitamins B1, B6, D and C following the MRP, which were not associated with changes in cardiovascular structure/function. In conclusion, changes in micronutrient status following the MRP were not independently associated with improvements in cardiovascular structure/function in people with T2D.
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Key Words
- BMI, body mass index
- CMR
- CMR, cardiac magnetic resonance imaging
- CVD, cardiovascular disease
- Cardiovascular function
- EF, ejection fraction
- HF, heart failure
- LV, left ventricular
- Low calorie
- Low-energy meal replacement plan
- MRP, meal replacement plan
- Micronutrients
- PLP, pyridoxal 5-phosphate
- RCT, randomised control trial
- T2D, type 2 diabetes
- Type 2 diabetes
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Affiliation(s)
- Grace W. M. Walters
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Emma Redman
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Gaurav S. Gulsin
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Joseph Henson
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | | | - Thomas Yates
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Melanie J. Davies
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kelly Parke
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Emer M. Brady
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
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35
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Restricting carbohydrates and calories in the treatment of type 2 diabetes: a systematic review of the effectiveness of 'low-carbohydrate' interventions with differing energy levels. J Nutr Sci 2021; 10:e76. [PMID: 34589208 PMCID: PMC8453456 DOI: 10.1017/jns.2021.67] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/04/2021] [Accepted: 08/18/2021] [Indexed: 11/25/2022] Open
Abstract
There are two proven dietary approaches to shift type 2 diabetes (T2D) into remission: low-energy diets (LEDs) and low-carbohydrate diets (LCDs). These approaches differ in their rationale and application yet both involve carbohydrate restriction, either as an explicit goal or as a consequence of reducing overall energy intake. The aims of this systematic review were to identify, characterise and compare existing clinical trials that utilised ‘low-carbohydrate’ interventions with differing energy intakes. Electronic databases CENTRAL, CINAHL, Embase, MEDLINE and Scopus were searched to identify controlled clinical trials in adults with T2D involving low-carbohydrate intake (defined as <130 g carbohydrate/d) and reporting weight and glycaemic outcomes. The initial database search yielded 809 results, of which fifteen studies met the inclusion criteria. Nine out of fifteen studies utilised LCDs with moderate or unrestricted energy intake. Six trials utilised LEDs (<1200 kcal/d), with all except one incorporating meal replacements as part of a commercial weight loss programme. Interventions using both restricted and unrestricted (ad libitum) energy intakes produced clinically significant weight loss and reduction in glycated haemoglobin (HbA1c) at study endpoints. Trials that restricted energy intake were not superior to those that allowed ad libitum low-carbohydrate feeding at 12 and 24 months. An association was observed across studies between average weight loss and reduction in HbA1c at 6, 12 and 24 months, indicating that sustained weight loss is key to T2D remission. Further research is needed to specifically ascertain the weight-independent effects of carbohydrate restriction on glycaemic control in T2D.
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36
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Mannucci E, Bonifazi A, Monami M. Comparison between different types of exercise training in patients with type 2 diabetes mellitus: A systematic review and network metanalysis of randomized controlled trials. Nutr Metab Cardiovasc Dis 2021; 31:1985-1992. [PMID: 33965297 DOI: 10.1016/j.numecd.2021.02.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/20/2022]
Abstract
AIM Aim of the present meta-analysis and network metanalysis (NMA) is the assessment of the effects of physical exercise on glucose control and cardiovascular risk factors in type 2 diabetes. DATA SYNTHESIS This metanalysis includes all available trials exploring the effects of different exercise modalities in type 2 diabetes, with a duration of ≥3 months. The standardized difference in means (SDM) with 95% Confidence Intervals were calculated. Data were analyzed using MetaXL and Rev Man 5.0. Primary endpoint was the effect of exercise versus no exercise on HbA1c and fasting plasma glucose (FPG) at endpoint. Secondary endpoints were body weight and fat, waist circumference, and blood pressure. A comparison of different exercise training modalities (aerobic, resistance and combined) for the same endpoints was also performed, choosing 'no exercise' as the reference for indirect comparisons. We included 25 trials fulfilling all inclusion criteria. Physical exercise versus no exercise produced a small, but significant, improvement of HbA1c, body fat, and systolic blood pressure at endpoint (-0.3 [-0.1;-0.4]%, -1.44 [-2.22, -0.66]%, and -5.6 [-9.5, -1.6] mmHg, respectively). Combined, supervised aerobic and resistance exercise were associated with a significantly greater reduction of HbA1c (SDM, -0.4 [-0.6;-0.3], -0.2 [-0.4;-0.1], and -0.2 [-0.3;-0.1]%, respectively), but not of FPG, in comparison with no exercise. CONCLUSIONS Physical exercise produces small, but detectable, advantages on glycemic control and cardiovascular risk factors and should be suggested in type 2 diabetes. Combined aerobic/resistance training seems to be superior to aerobic training alone, but differences are small and the reliability of supporting evidence limited.
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Affiliation(s)
- Edoardo Mannucci
- Diabetology, Careggi Hospital, Florence, Italy; University of Florence, Italy
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37
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Ren J, Wu NN, Wang S, Sowers JR, Zhang Y. Obesity cardiomyopathy: evidence, mechanisms, and therapeutic implications. Physiol Rev 2021; 101:1745-1807. [PMID: 33949876 PMCID: PMC8422427 DOI: 10.1152/physrev.00030.2020] [Citation(s) in RCA: 138] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The prevalence of heart failure is on the rise and imposes a major health threat, in part, due to the rapidly increased prevalence of overweight and obesity. To this point, epidemiological, clinical, and experimental evidence supports the existence of a unique disease entity termed “obesity cardiomyopathy,” which develops independent of hypertension, coronary heart disease, and other heart diseases. Our contemporary review evaluates the evidence for this pathological condition, examines putative responsible mechanisms, and discusses therapeutic options for this disorder. Clinical findings have consolidated the presence of left ventricular dysfunction in obesity. Experimental investigations have uncovered pathophysiological changes in myocardial structure and function in genetically predisposed and diet-induced obesity. Indeed, contemporary evidence consolidates a wide array of cellular and molecular mechanisms underlying the etiology of obesity cardiomyopathy including adipose tissue dysfunction, systemic inflammation, metabolic disturbances (insulin resistance, abnormal glucose transport, spillover of free fatty acids, lipotoxicity, and amino acid derangement), altered intracellular especially mitochondrial Ca2+ homeostasis, oxidative stress, autophagy/mitophagy defect, myocardial fibrosis, dampened coronary flow reserve, coronary microvascular disease (microangiopathy), and endothelial impairment. Given the important role of obesity in the increased risk of heart failure, especially that with preserved systolic function and the recent rises in COVID-19-associated cardiovascular mortality, this review should provide compelling evidence for the presence of obesity cardiomyopathy, independent of various comorbid conditions, underlying mechanisms, and offer new insights into potential therapeutic approaches (pharmacological and lifestyle modification) for the clinical management of obesity cardiomyopathy.
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Affiliation(s)
- Jun Ren
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China.,Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Ne N Wu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China
| | - Shuyi Wang
- School of Medicine, Shanghai University, Shanghai, China.,University of Wyoming College of Health Sciences, Laramie, Wyoming
| | - James R Sowers
- Dalton Cardiovascular Research Center, Diabetes and Cardiovascular Research Center, University of Missouri-Columbia, Columbia, Missouri
| | - Yingmei Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, Shanghai, China
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38
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Gönül S, Namlı T, Coşar A, Toroslu İH. A reinforcement learning based algorithm for personalization of digital, just-in-time, adaptive interventions. Artif Intell Med 2021; 115:102062. [PMID: 34001322 DOI: 10.1016/j.artmed.2021.102062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 03/04/2021] [Accepted: 03/29/2021] [Indexed: 01/13/2023]
Abstract
Suboptimal health related behaviors and habits; and resulting chronic diseases are responsible for majority of deaths globally. Studies show that providing personalized support to patients yield improved results by preventing and/or timely treatment of these problems. Digital, just-in-time and adaptive interventions are mobile phone-based notifications that are being utilized to support people wherever and whenever necessary in coping with their health problems. In this research, we propose a reinforcement learning-based mechanism to personalize interventions in terms of timing, frequency and preferred type(s). We simultaneously employ two reinforcement learning models, namely intervention-selection and opportune-moment-identification; capturing and exploiting changes in people's long-term and momentary contexts respectively. While the intervention-selection model adapts the intervention delivery with respect to type and frequency, the opportune-moment-identification model tries to find the most opportune moments to deliver interventions throughout a day. We propose two accelerator techniques over the standard reinforcement learning algorithms to boost learning performance. First, we propose a customized version of eligibility traces for rewarding past actions throughout an agent's trajectory. Second, we utilize the transfer learning method to reuse knowledge across multiple learning environments. We validate the proposed approach in a simulated experiment where we simulate four personas differing in their daily activities, preferences on specific intervention types and attitudes towards the targeted behavior. Our experiments show that the proposed approach yields better results compared to the standard reinforcement learning algorithms and successfully capture the simulated variations associated with the personas.
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Affiliation(s)
- Suat Gönül
- SRDC Corp., Silikon Blok Kat: 1 No: 16 SRDC Teknokent ODTÜ, Ankara, Turkey.
| | - Tuncay Namlı
- SRDC Corp., Silikon Blok Kat: 1 No: 16 SRDC Teknokent ODTÜ, Ankara, Turkey
| | - Ahmet Coşar
- Department of Computer Engineering, Middle East Technical University, Orta Doğu Teknik Üniversitesi Universiteler Mah. Dumlupinar Blv. No:1 06800, Ankara Turkey
| | - İsmail Hakkı Toroslu
- Department of Computer Engineering, Middle East Technical University, Orta Doğu Teknik Üniversitesi Universiteler Mah. Dumlupinar Blv. No:1 06800, Ankara Turkey
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39
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Bilak JM, Gulsin GS, McCann GP. Cardiovascular and systemic determinants of exercise capacity in people with type 2 diabetes mellitus. Ther Adv Endocrinol Metab 2021; 12:2042018820980235. [PMID: 33552463 PMCID: PMC7844448 DOI: 10.1177/2042018820980235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/20/2020] [Indexed: 12/15/2022] Open
Abstract
The global burden of heart failure (HF) is on the rise owing to an increasing incidence of lifestyle related diseases, predominantly type 2 diabetes mellitus (T2D). Diabetes is an independent risk factor for cardiovascular disease, and up to 75% of those with T2D develop HF in their lifetime. T2D leads to pathological alterations within the cardiovascular system, which can progress insidiously and asymptomatically in the absence of conventional risk factors. Reduced exercise tolerance is consistently reported, even in otherwise asymptomatic individuals with T2D, and is the first sign of a failing heart. Because aggressive modification of cardiovascular risk factors does not eliminate the risk of HF in T2D, it is likely that other factors play a role in the pathogenesis of HF. Early identification of individuals at risk of HF is advantageous, as it allows for modification of the reversible risk factors and early initiation of treatment with the aim of improving clinical outcomes. In this review, cardiac and extra-cardiac contributors to reduced exercise tolerance in people with T2D are explored.
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Affiliation(s)
- Joanna M. Bilak
- Department of Cardiovascular Sciences, University of Leicester and The National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Gaurav S. Gulsin
- Department of Cardiovascular Sciences, University of Leicester and The National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE39QP, UK
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40
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Gulsin GS, Brady E, Marsh AM, Squire G, Htike ZZ, Wilmot EG, Biglands JD, Kellman P, Xue H, Webb DR, Khunti K, Yates T, Davies MJ, McCann GP. Clinical associations with stage B heart failure in adults with type 2 diabetes. Ther Adv Endocrinol Metab 2021; 12:20420188211030144. [PMID: 34349975 PMCID: PMC8287269 DOI: 10.1177/20420188211030144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/16/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is a high prevalence of asymptomatic (American Heart Association Stage B) heart failure (SBHF) in people with type 2 diabetes (T2D). We aimed to identify associations between clinical characteristics and markers of SBHF in adults with T2D, which may allow therapeutic interventions prior to symptom onset. METHODS Adults with T2D from a multi-ethnic population with no prevalent cardiovascular disease [n = 247, age 52 ± 12 years, glycated haemoglobin A1c (HbA1c) 7.4 ± 1.1% (57 ± 12 mmol/mol), duration of diabetes 61 (32, 120) months] underwent echocardiography and adenosine stress perfusion cardiovascular magnetic resonance imaging. Multivariable linear regression analyses were performed to identify independent associations between clinical characteristics and markers of SBHF. RESULTS In a series of multivariable linear regression models containing age, sex, ethnicity, smoking history, number of glucose-lowering agents, systolic blood pressure (BP) duration of diabetes, body mass index (BMI), HbA1c, serum creatinine, and low-density lipoprotein (LDL)-cholesterol, independent associations with: left ventricular mass:volume were age (β = 0.024), number of glucose-lowering agents (β = 0.022) and systolic BP (β = 0.027); global longitudinal strain were never smoking (β = -1.196), systolic BP (β = 0.328), and BMI (β = -0.348); myocardial perfusion reserve were age (β = -0.364) and male sex (β = 0.458); and aortic distensibility were age (β = -0.629) and systolic BP (β = -0.348). HbA1c was not independently associated with any marker of SBHF. CONCLUSIONS In asymptomatic adults with T2D, age, systolic BP, BMI, and smoking history, but not glycaemic control, are the major determinants of SBHF. Given BP and BMI are modifiable, these may be important targets to reduce the development of symptomatic heart failure.
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Affiliation(s)
| | - Emer Brady
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Anna-Marie Marsh
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Gareth Squire
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Zin Z. Htike
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, UK
| | - Emma G. Wilmot
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | - Peter Kellman
- National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Hui Xue
- National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - David R. Webb
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, UK
| | - Tom Yates
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, UK
| | - Melanie J. Davies
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, UK
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
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41
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Tadic M, Suzic-Lazic J, Vukomanovic V, Cuspidi C, Ilic S, Celic V. Functional capacity and left ventricular diastolic function in patients with type 2 diabetes. Acta Diabetol 2021; 58:107-113. [PMID: 32888068 DOI: 10.1007/s00592-020-01600-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022]
Abstract
AIMS The study sought to evaluate cardiorespiratory fitness in patients with type 2 diabetes mellitus (DM) with different levels of left ventricular (LV) diastolic dysfunction (LVDD). METHODS This investigation included 55 controls and 85 uncomplicated diabetic patients, who underwent laboratory analysis, echocardiographic evaluation and cardiopulmonary exercise testing. All DM subjects were separated into 3 groups using the level of LV diastolic function as main criterion: normal, intermediate and LVDD. RESULTS Echocardiographic parameters of LV hypertrophy were significantly higher in DM subjects, particularly those with intermediate LV diastolic function and LVDD comparing with controls. The same is valid for parameters of LV diastolic function (E/e', left atrial volume index and tricuspid regurgitation velocity). Peak oxygen uptake was lower, whereas ventilation/carbon dioxide slope was higher, in DM subjects with intermediate LV diastolic function and LVDD in comparison to controls. In the whole study population HbA1c, LV mass index and mitral E/e' were independently related with peak oxygen uptake and ventilation/carbon dioxide slope. CONCLUSIONS LVDD significantly impacted functional capacity in DM patients. Glycemic control, LV mass index and LVDD were independently related with peak oxygen consumption and ventilation/carbon dioxide slope in the study population. These results show that timely diagnosis of LVDD and more intensive antidiabetic treatment could prevent target organ damage in DM patients.
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Affiliation(s)
- Marijana Tadic
- Department of Cardiology, University Hospital "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia.
| | - Jelena Suzic-Lazic
- Department of Cardiology, University Hospital "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Vladan Vukomanovic
- Department of Cardiology, University Hospital "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano IRCCS, Viale della Resistenza 23, 20036, Meda, Italy
| | - Sanja Ilic
- Department of Endocrinology, University Hospital "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Vera Celic
- Department of Cardiology, University Hospital "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia
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Gulsin GS, Henson J, Brady EM, Sargeant JA, Wilmot EG, Athithan L, Htike ZZ, Marsh AM, Biglands JD, Kellman P, Khunti K, Webb D, Davies MJ, Yates T, McCann GP. Cardiovascular Determinants of Aerobic Exercise Capacity in Adults With Type 2 Diabetes. Diabetes Care 2020; 43:2248-2256. [PMID: 32680830 PMCID: PMC7440912 DOI: 10.2337/dc20-0706] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/09/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the relationship between subclinical cardiac dysfunction and aerobic exercise capacity (peak VO2) in adults with type 2 diabetes (T2D), a group at high risk of developing heart failure. RESEARCH DESIGN AND METHODS Cross-sectional study. We prospectively enrolled a multiethnic cohort of asymptomatic adults with T2D and no history, signs, or symptoms of cardiovascular disease. Age-, sex-, and ethnicity-matched control subjects were recruited for comparison. Participants underwent bioanthropometric profiling, cardiopulmonary exercise testing, and cardiovascular magnetic resonance with adenosine stress perfusion imaging. Multivariable linear regression analysis was undertaken to identify independent associations between measures of cardiovascular structure and function and peak VO2. RESULTS A total of 247 adults with T2D (aged 51.8 ± 11.9 years, 55% males, 37% black or south Asian ethnicity, HbA1c 7.4 ± 1.1% [57 ± 12 mmol/mol], and duration of diabetes 61 [32-120] months) and 78 control subjects were included. Subjects with T2D had increased concentric left ventricular remodeling, reduced myocardial perfusion reserve (MPR), and markedly lower aerobic exercise capacity (peak VO2 18.0 ± 6.6 vs. 27.8 ± 9.0 mL/kg/min; P < 0.001) compared with control subjects. In a multivariable linear regression model containing age, sex, ethnicity, smoking status, and systolic blood pressure, only MPR (β = 0.822; P = 0.006) and left ventricular diastolic filling pressure (E/e') (β = -0.388; P = 0.001) were independently associated with peak VO2 in subjects with T2D. CONCLUSIONS In a multiethnic cohort of asymptomatic people with T2D, MPR and diastolic function are key determinants of aerobic exercise capacity, independent of age, sex, ethnicity, smoking status, or blood pressure.
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Affiliation(s)
- Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K.
| | - Joseph Henson
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Emer M Brady
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Jack A Sargeant
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Emma G Wilmot
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, U.K
| | - Lavanya Athithan
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Zin Z Htike
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, U.K
| | - Anna-Marie Marsh
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | | | - Peter Kellman
- National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - David Webb
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K.
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Abstract
Functional capacity represents an important predictor for cardiovascular and all-cause mortality in patients with diabetes mellitus (DM). Impaired cardiopulmonary fitness is frequently seen in DM patients, and it might partly explain morbidity and mortality in these patients. There are several potential reasons that could explain impaired functional capacity in DM patients: hyperglycemia, insulin resistance, endothelial dysfunction, inflammation, microvascular impairment, myocardial dysfunction, and skeletal muscle changes. These changes are partly reversible, and improvement of any of these components might increase functional capacity in DM patients and improve their outcome. Physical activity is related with decreased cardiovascular disease and all-cause mortality in patients with type 2 DM. Diabetic cardiomyopathy is the most important clinical entity in DM patients that involves left ventricular diastolic dysfunction and cardiac autonomic neuropathy, which potentially induce heart failure with preserved ejection fraction. Development of diabetic cardiomyopathy may slow oxygen uptake kinetics and affect the cardiorespiratory fitness in DM patients, but it can also induce development of heart failure. Improvement of functional capacity in DM patients represents an important therapeutic task, and it can be achieved mainly with exercise training and significantly less with pharmacological treatment. Exercise training reduces body weight and improves glycemic control, as well as left ventricular structure and function. The aim of this review was to summarize current knowledge about importance of functional capacity in DM patients, as well as possible mechanisms that could explain the relationship between DM and oxygen kinetics.
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