A study recently published in Diabetes Care has shown that exercise may be the best way
to improve heart function in adults with type 2 diabetes – but a specialized diet can
reverse the condition.
Heart failure is a common complication of diabetes, and signs of future trouble can show
up as changes to heart function in younger adults. Investigators compared the impact of
supervised aerobic exercise and a low-energy meal replacement program on heart function
in 87 patients ages 18 to 65 with the disease. Participants underwent echocardiography
and magnetic resonance imaging to confirm early heart dysfunction, and exercise tests to
measure cardiovascular fitness. This study which is a prospective, randomized, open-label,
blinded end point trial with nested case-control study. Asymptomatic younger adults with
T2D were randomized 1:1:1 to a 12-week intervention of 1) routine care, 2) supervised
aerobic exercise training, or 3) a low-energy (∼810 kcal/day) MRP. Participants underwent
echocardiography, cardiopulmonary exercise testing, and cardiac magnetic resonance (CMR)
at baseline and 12 weeks. The primary outcome was change in left ventricular (LV) peak
early diastolic strain rate (PEDSR) as measured by CMR. Healthy volunteers were enrolled
for baseline case-control comparison.
Eighty-seven participants with T2D (age 51 ± 7 years, HbA1c 7.3 ± 1.1%) and 36 matched
control participants were included. At baseline, those with T2D had evidence of diastolic
dysfunction (PEDSR 1.01 ± 0.19 vs. 1.10 ± 0.16 s−1, P = 0.02) compared with control participants.
Seventy-six participants with T2D completed the trial (30 routine care, 22 exercise, and
24 MRP). The MRP arm lost 13 kg in weight and had improved blood pressure, glycemia, LV
mass/volume, and aortic stiffness. The exercise arm had negligible weight loss but increased
exercise capacity. PEDSR increased in the exercise arm versus routine care (β = 0.132, P = 0.002)
but did not improve with the MRP (β = 0.016, P = 0.731).
Significant improvements in heart function were found in exercise program participants when
compared with a control group. These patients also had an increase in exercise capacity. In
contrast, the low energy diet did not improve heart function, but the intervention certainly
was not a total loss. Patients in the diet group not only had “favorable” changes to heart
structure and vascular function, but 83% in this cohort experienced a reversal of their diabetes,
reported Prof. Gerry McCann, from the University of Leicester, United Kingdom.