University of Queensland, Brisbane, Australia.
Circ Heart Fail. 2011 Jul;4(4):441-9. doi: 10.1161/CIRCHEARTFAILURE.110.959312. Epub 2011 May 16.
Diastolic dysfunction (DD) is associated with adverse cardiovascular outcomes. We studied the impact of an exercise-based lifestyle intervention on the evolution of DD in patients with type 2 diabetes mellitus (T2DM) and prospectively investigated the clinical correlates of DD progression.
A total of 223 outpatients with T2DM were randomized to supervised exercise-based lifestyle intervention (initial gym-based program and lifestyle and diet advice followed by telephone-guided supervision) or usual care. Patients underwent echocardiographic assessment of diastolic function and metabolic and clinical evaluation at baseline and 3 years. Changes in prevalence and evolution of DD were assessed and correlations sought with clinical and metabolic variables. DD was present in 50% of patients at baseline and 54% at 3 years, with no difference between the usual care and intervention groups (60% versus 48%, P=0.10). Abnormal DD at the final visit was independently associated with older age and a decrease in peak oxygen consumption over time (P<0.05). There was no impact on glycemic control or exercise capacity. In a subanalysis restricted to patients who finished the full 3-year follow-up, control subjects were independently associated with DD at 3 years (β=0.90; odds ratio, 2.46; P=0.034), with the only other independent correlate being older age (β=0.05; odds ratio, 1.06; P=0.019).
Despite being efficacious in the subgroup who completed 3 years of exercise-based lifestyle intervention, randomization to this program was not effective in reducing progression of subclinical DD in patients with T2DM, which may reflect the recognized difficulty of adherence to prolonged exercise intervention.
URL: http://www.anzctr.org.au. Unique identifier: ACTRN12607000060448.
舒张功能障碍（DD）与不良心血管结局相关。我们研究了基于运动的生活方式干预对 2 型糖尿病（T2DM）患者 DD 进展的影响，并前瞻性调查了 DD 进展的临床相关性。
共有 223 例 T2DM 门诊患者被随机分为监督下的基于运动的生活方式干预组（初始健身房计划和生活方式及饮食建议，随后进行电话指导监督）或常规护理组。患者在基线和 3 年时接受超声心动图评估舒张功能以及代谢和临床评估。评估 DD 的患病率变化和进展，并寻求与临床和代谢变量的相关性。基线时 50%的患者存在 DD，3 年后为 54%，常规护理组和干预组之间无差异（60%比 48%，P=0.10）。终末随访时异常 DD 与年龄较大和峰值耗氧量随时间下降独立相关（P<0.05）。对血糖控制或运动能力无影响。在限制完成完整 3 年随访的患者的亚分析中，对照组患者在 3 年后独立存在 DD（β=0.90；比值比，2.46；P=0.034），唯一其他独立相关因素是年龄较大（β=0.05；比值比，1.06；P=0.019）。
尽管在完成 3 年基于运动的生活方式干预的亚组中有效，但随机分组到该方案并不能有效减少 T2DM 患者亚临床 DD 的进展，这可能反映了坚持长期运动干预的公认困难。
