Effects of lifestyle modification on metabolic parameters and carotid intima-media thickness in patients with type 2 diabetes mellitus
Introduction
Type 2 diabetes mellitus is a rapidly growing chronic health problem, and the accompanying long-term microvascular and macrovascular complications cause significant morbidity and mortality in patients with diabetes. The onset and progression of atherosclerosis are much more rapid in individuals with diabetes than in those without diabetes. The increased prevalence of cardiovascular disease in patients with diabetes is preceded by a constellation of risk factors including dyslipidemia, hypertension, and obesity [1]. These risk factors, together with hyperglycemia itself, act in concert to create a very potent atherogenic situation, resulting in catastrophic results such as acute myocardial infarction or stroke [2]. Tight glycemic control, weight loss, the improvement of insulin resistance, and the correction of dyslipidemia contribute to the prevention of atherosclerosis in patients with diabetes [3].
Lifestyle is known to be an important factor in glycemic control and the development and progression of atherosclerosis. The Lifestyle Heart Trial and subsequent studies showed that lifestyle changes could lead to a reduction in the atherosclerotic progression of the coronary artery [4], [5]. Ultrasound measurement of the carotid intima-media thickness (IMT) is a reliable measure of early atherosclerosis. [6], [7]. Several studies have shown that increased carotid IMT confers risk of future coronary heart disease and stroke [8], [9], [10]. There are conflicting results on the effects of lifestyle modification on carotid IMT in nondiabetes [11], [12], [13], [14], [15], [16]. However, to our knowledge, there have been no previous studies examining the effects of lifestyle modification on carotid IMT in type 2 diabetes mellitus. In this study, we examined the effects of a 6-month intensive lifestyle modification intervention on glycemic control, blood pressure, dyslipidemia, obesity, and carotid IMT in patients with type 2 diabetes mellitus.
Section snippets
Study subjects
Fifty-eight subjects with type 2 diabetes mellitus were recruited from the outpatient clinic at the Yonsei University Severance Hospital Diabetes Center (Seoul, Korea). Diabetes was defined according to the 1997 American Diabetes Association diagnostic criteria [17]. The inclusion criteria for patients were as follows: (1) treatment with oral hypoglycemic agents or diet and exercise alone, not with insulin therapy; (2) HbA1c level of higher than 7.0%; (3) no change in any medications for the
Baseline characteristics
Baseline clinical and demographic characteristics did not differ significantly between the intervention and control groups (Table 1). Overall, subjects had a mean age of 54.4 years, a diabetes duration of 8.8 years, and an HbA1c of 8.8%. Seventy-six percent of the participants were women, and 57% of the participants were obese (defined as body mass index [BMI] ≥25 kg/m2 [23]).
Compliance and adherence to the intensive lifestyle modification intervention
Adherence to the intervention program was judged by attendance of the 16-lesson curriculum during the first 16 weeks of
Discussion
Our results suggest that an intensive lifestyle modification intervention for 6 months in patients with type 2 diabetes mellitus can improve glycemic control, lower blood pressure, promote moderate weight loss, and attenuate the progression of carotid IMT. To our knowledge, this is the first study to evaluate the changes in carotid IMT in addition to other metabolic parameters in type 2 diabetic patients after a 6-month intensive lifestyle modification intervention. A lower HbA1c is associated
Acknowledgment
This study was supported by a grant from the Korean Research Foundation (KRF-2004-041-E00345) and the Brain Korea 21 Project for Medical Science, Yonsei University.
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