Effects of lifestyle modification on metabolic parameters and carotid intima-media thickness in patients with type 2 diabetes mellitus

doi:10.1016/j.metabol.2006.03.017

Metabolism

Volume 55, Issue 8, August 2006, Pages 1053-1059

https://doi.org/10.1016/j.metabol.2006.03.017 Get rights and content

Abstract

The aim of this study was to examine the effects of a 6-month intensive lifestyle modification intervention on metabolic parameters and carotid intima-media thickness (IMT) in patients with type 2 diabetes mellitus. Fifty-eight subjects with type 2 diabetes mellitus were randomly assigned to the intervention group or the control group. The subjects in the intervention group participated in a 16-week intensive lifestyle modification program and subsequent monthly meetings during the 6-month study period. Control subjects received basic dietary education and usual care. Anthropometric data, metabolic parameters, and carotid IMT were examined before the intervention and after 6 months. Lifestyle modification intervention group patients showed a significant reduction in HbA_1c (−1.0% ± 1.3% vs +0.1% ± 1.2%, P = .002), fasting blood glucose (−1.6 ± 1.5 vs +0.3 ± 2.5 mmol/L, P = .001), and 2-hour postprandial plasma glucose (−2.1 ± 2.5 vs +0.8 ± 4.4 mmol/L, P = .003) compared with control patients after 6 months. Body weight (−2.0 ± 2.6 vs +0.2 ± 1.7 kg, P = .001), body mass index (−0.8 ± 1.0 vs 0.0 ± 0.8 kg/m², P = .003), and systolic blood pressure (−8.2 ± 15.9 vs +0.4 ± 14.1 mm Hg, P = .041) were significantly decreased in the intervention group. A significantly reduced carotid mean IMT progression was seen in the intervention group after 6 months (−0.040 ± 0.136 vs +0.083 ± 0.167 mm, P = .007). Changes in HbA_1c (r = 0.34, P = .028), fasting plasma glucose (r = 0.31, P = .045), and 2-hour postprandial plasma glucose (r = 0.37, P = .015) correlated with the mean carotid IMT change after adjustment for age and sex. In conclusion, a 6-month intensive lifestyle modification intervention in patients with type 2 diabetes mellitus resulted in improved glycemic control and decreased progression of carotid IMT.

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) HbA_1c 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 HbA_1c 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 HbA_1c 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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Effects of lifestyle modification on metabolic parameters and carotid intima-media thickness in patients with type 2 diabetes mellitus

Abstract

Introduction

Section snippets

Study subjects

Baseline characteristics

Compliance and adherence to the intensive lifestyle modification intervention

Discussion

Acknowledgment

Lancet

Am Heart J

Am J Clin Nutr

Am J Cardiol

Atherosclerosis

Diabetes Res Clin Pract

Kidney Int

Endocrinol Metab Clin North Am

Metabolism

Diabetes Res Clin Pract

Diabetes and cardiovascular disease. The Framingham study

JAMA

Prevalence and mortality of acute myocardial infarction in patients with diabetes

Diabetes Care

Abdominal obesity predicts declining insulin sensitivity in non-obese normoglycemics: the Insulin Resistance Atherosclerosis Study (IRAS)

Diabetes Obes Metab

Regular physical exercise and low-fat diet. Effects on progression of coronary artery disease

Circulation

George Lyman Duff Memorial Lecture: arterial imaging and atherosclerosis reversal

Arterioscler Thromb

The role of carotid arterial intima-media thickness in predicting clinical coronary events

Ann Intern Med

Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults

N Engl J Med

Is carotid intima-media thickness useful in cardiovascular disease risk assessment? The Rotterdam Study

Stroke

The influence of lifestyle modification on carotid intima-media thickness in a suburban Japanese population

Atherosclerosis

Multiple risk intervention trial in high risk hypertensive men: comparison of ultrasound intima-media thickness and clinical outcome during 6 years of follow-up

J Intern Med