Influence of glycemic control on gain in VO2 peak, in patients with type 2 diabetes enrolled in cardiac rehabilitation after an acute coronary syndrome. The prospective DARE study

BMC Cardiovascular Disorders

Michel Fischbach⁴  Bogdan Catargi⁵  Hervé Douard³  Jean-Michel Feige¹  Jean-Henri Bertrand¹  Isabelle Simoneau-Robin²  Marie-Christine Iliou⁶  Bénédicte Patois-Vergès⁷  Bruno Vergès² 

[1] Unité de réadaptation cardiaque, Clinique du Lavarin, Avignon, France;Service endocrinologie, diabétologie, CHU Le Bocage, Dijon, 21000, France;Service réadaptation cardiaque, Hôpital du Haut Lévêque, Pessac, France;URCA, Bordeaux, France;Service endocrinologie, diabétologie, Hôpital du Haut Lévêque, Pessac, France;Service réadaptation cardiaque, Hôpital Corentin Celton, Issy les Moulineaux, France;Unité de réadaptation cardiaque, Clinique Les Rosiers, Dijon, France

关键词: Hyperglycemia;    Myocardial infarction;    Cardiac rehabilitation;    Diabetes;   

Others  :  1217883
DOI  :  10.1186/s12872-015-0055-8

 received in 2015-01-21, accepted in 2015-06-10,  发布年份 2015

【 摘 要 】

Background

Gain in VO2 peak after cardiac rehabilitation (CR) following an acute coronary syndrome (ACS), is associated with reduced mortality and morbidity. We have previously shown in CR, that gain in VO2 peak is reduced in Type 2 diabetic patients and that response to CR is impaired by hyperglycemia.

Methods

We set up a prospective multicenter study (DARE) whose primary objective was to determine whether good glycemic control during CR may improve the gain in VO2 peak. Sixty four type 2 diabetic patients, referred to CR after a recent ACS, were randomized to insulin intensive therapy or a control group with continuation of the pre-CR antidiabetic treatment. The primary objective was to study the effect of glycemic control during CR on the improvement of peak VO2 by comparing first the 2 treatment groups (insulin intensive vs. control) and second, 2 pre-specified glycemic control groups according to the final fructosamine level (below and above the median).

Results

At the end of the CR program, the gain in VO2 peak and the final fructosamine level (assessing glycemic level during CR) were not different between the 2 treatment groups. However, patients who had final fructosamine level below the median value, assessing good glycemic control during CR, showed significantly higher gain in VO2 peak (3.5 ± 2.4 vs. 1.7 ± 2.4 ml/kg/min,p = 0.014) and ventilatory threshold (2.7 ± 2.5 vs. 1.2 ± 1.9 ml/kg/min,p = 0.04) and a higher proportion of good CR-responders (relative gain in VO2 peak ≥ 16 %): 66 % vs. 36 %, p = 0.011. In multivariate analysis, gain in VO2 peak was associated with final fructosamine level (p = 0.010) but not with age, gender, duration of diabetes, type of ACS, insulin treatment or basal fructosamine.

Conclusions

The DARE study shows that, in type 2 diabetes, good glycemic control during CR is an independent factor associated with gain in VO2 peak. This emphasizes the need for good glycemic control in CR for type 2 diabetic patients.

Trial registration

Trial registered as NCT00354237 (19 July 2006).

【 授权许可】

   
2015 Vergès et al.

【 图 表 】

Fig. 1.

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