Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in Type 2 diabetes mellitus

Background Cardiac autonomic neuropathy is a common complication of type 2 diabetes mellitus (T2DM), that can be measured through heart rate variability (HRV)–known to be decreased in T2DM. Physical exercise can improve HRV in healthy population, however results are under debate in T2DM. We conducted a systemic review and meta-analysis to assess the effects of physical exercise on HRV in T2DM patients. Method PubMed, Cochrane, Embase, and ScienceDirect databases were searched for all studies reporting HRV parameters in T2DM patients before and after exercise training, until September 20th 2020, without limitation to specific years. We conducted random-effects meta-analysis stratified by type of exercise for each of the HRV parameters: RR–intervals (or Normal to Normal intervals–NN), standard deviation of RR intervals (SDNN), percentage of adjacent NN intervals varying by more than 50 milliseconds (pNN50), root mean square of successive RR-intervals differences (RMSSD), total power, Low Frequency (LF), High Frequency (HF) and LF/HF ratio. Sensitivity analyses were computed on studies with the highest quality. Results We included 21 studies (9 were randomized) for a total of 523 T2DM patients: 472 had an exercise training and 151 were controls (no exercise). Intervention was endurance (14 studies), resistance (2 studies), endurance combined with resistance (4 studies), and high intensity interval training (HIIT) (4 studies). After exercise training, all HRV parameters improved i.e. an increase in SDNN (effect size = 0.59, 95%CI 0.26 to 0.93), RMSSD (0.62, 0.28 to 0.95), pNN50 (0.62, 0.23 to 1.00), HF (0.58, -0.16 to 0.99), and a decrease in LF (-0.37, -0.69 to -0.05) and LF/HF (-0.52, -0.79 to -0.24). There were no changes in controls. Stratification by type of exercise showed an improvement in most HRV parameters (SDNN, RMSSD, pNN50, LF, HF, LF/HF) after endurance training, whereas mostly LF/HF was improved after both resistance training and HIIT. Supervised training improved most HRV parameters. Duration and frequency of training did not influence the benefits on HRV. Conclusion Exercise training improved HRV parameters in T2DM patients which may reflect an improvement in the activity of the autonomic nervous system. The level of proof is the highest for endurance training. Supervised training seemed beneficial.

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Exercise training for patients with type 2 diabetes and cardiovascular disease: What to pursue and how to do it. A Position Paper of the European Association of Preventive Cardiology (EAPC)

European Journal of Preventive Cardiology ◽

10.1177/2047487318820420 ◽

2019 ◽

Vol 26 (7) ◽

pp. 709-727 ◽

Cited By ~ 26

Author(s):

Hareld Kemps ◽

Nicolle Kränkel ◽

Marcus Dörr ◽

Trine Moholdt ◽

Matthias Wilhelm ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Type 2 Diabetes Mellitus ◽

Exercise Training ◽

Cardiorespiratory Fitness ◽

Coronary Intervention ◽

Position Paper ◽

Treatment Targets

Patients with type 2 diabetes mellitus suffer from dysregulation of a plethora of cardiovascular and metabolic functions, including dysglycaemia, dyslipidaemia, arterial hypertension, obesity and a reduced cardiorespiratory fitness. Exercise training has the potential to improve many of these functions, such as insulin sensitivity, lipid profile, vascular reactivity and cardiorespiratory fitness, particularly in type 2 diabetes mellitus patients with cardiovascular comorbidities, such as patients that suffered from an acute myocardial infarction, or after a coronary intervention such as percutaneous coronary intervention or coronary artery bypass grafting. The present position paper aims to provide recommendations for prescription of exercise training in patients with both type 2 diabetes mellitus and cardiovascular disease. The first part discusses the relevance and practical applicability of treatment targets that may be pursued, and failure to respond to these targets. The second part provides recommendations on the contents and methods to prescribe exercise training tailored to these treatment targets as well as to an optimal preparation and dealing with barriers and risks specific to type 2 diabetes mellitus and cardiac comorbidity.

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Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis

International Journal of Behavioral Nutrition and Physical Activity ◽

10.1186/s12966-018-0703-3 ◽

2018 ◽

Vol 15 (1) ◽

Cited By ~ 46

Author(s):

Bei Pan ◽

Long Ge ◽

Yang-qin Xun ◽

Ya-jing Chen ◽

Cai-yun Gao ◽

...

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Exercise Training ◽

Meta Analysis ◽

Training Modalities

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Systematic Literature Review and Network Meta-analysis (NMA) of SGLT2i as Monotherapy for Type 2 Diabetes Mellitus (T2DM)

Diabetes ◽

10.2337/db18-1159-p ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 1159-P

Author(s):

GLENN M. DAVIES ◽

ANN MARIE MCNEILL ◽

ELIZA KRUGER ◽

STACEY L. KOWAL ◽

FLAVIA EJZYKOWICZ ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Literature Review ◽

Systematic Literature Review ◽

Meta Analysis

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Plant-based diet and risk of type 2 diabetes mellitus: a systematic review and meta-analysis

International Journal of Medicine in Developing Countries ◽

10.24911/ijmdc.51-1592898007 ◽

2020 ◽

pp. 1301-1306

Author(s):

Arwa Aljabali ◽

Roaa Maghrabi ◽

Ahmad Shok ◽

Ghufran Alshawmali ◽

Abdullah Alqahtani ◽

...

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Meta Analysis

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Cinammon (Cinnamomum Spp.) and Type 2 Diabetes Mellitus

Current Topics in Nutraceutical Research ◽

10.37290/ctnr2641-452x.18:247-255 ◽

2019 ◽

Vol 18 (3) ◽

pp. 247-255

Author(s):

Sierra-Puente D. ◽

Abadi-Alfie S. ◽

Arakanchi-Altaled K. ◽

Bogard-Brondo M. ◽

García-Lascurain M. ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Systematic Reviews ◽

Meta Analysis ◽

Fasting Blood Glucose ◽

Tolerance Test ◽

Oral Glucose ◽

Key Aspects

Spices such as cinnamon (Cinnamomum Spp.) have been of interest due to their phytochemical composition that exert hypoglycemic effects with potential for management of type 2 diabetes mellitus (T2DM). We summarize data from 27 manuscripts that include, one book chapter, 3 review articles, 10 randomized controlled trials, 4 systematic reviews with meta-analysis, and 9 preclinical studies. The most frequently used cinnamon variety was Cinnamomum cassia rather than the Cinnamomum zeylanicum, whereas outcomes were defined as fasting blood glucose, glycated hemoglobin, and oral glucose tolerance test. A great variability in methodology such as different doses (from 120 mg to 6 g), duration of intervention, data retrieved and use of different concomitant medication, were found to be key aspects of most of trials and systematic reviews with meta-analysis available to date. Low quality studies have been made in most cases with a lot of heterogeneity clouding significance of results. More research needs to be done in order to yield accurate evidence for evidence-based recommendations. Its use is not currently a reliable nor advisable option for the treatment of T2DM.

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The GSTM1 and GSTT1 Null Genotypes Increase the Risk for Type 2 Diabetes Mellitus and the Subsequent Development of Diabetic Complications: A Meta-analysis

Current Diabetes Reviews ◽

10.2174/1573399814666171215120228 ◽

2018 ◽

Vol 15 (1) ◽

pp. 31-43 ◽

Cited By ~ 6

Author(s):

Sayantan Nath ◽

Sambuddha Das ◽

Aditi Bhowmik ◽

Sankar Kumar Ghosh ◽

Yashmin Choudhury

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Meta Analysis ◽

Subsequent Development ◽

Asian Population ◽

Gstm1 Null Genotype ◽

Increased Risk

Background:Studies pertaining to association of GSTM1 and GSTT1 null genotypes with risk of T2DM and its complications were often inconclusive, thus spurring the present study.Methods:Meta-analysis of 25 studies for evaluating the role of GSTM1/GSTT1 null polymorphisms in determining the risk for T2DM and 17 studies for evaluating the role of GSTM1/GSTT1 null polymorphisms in development of T2DM related complications were conducted.Results:Our study revealed an association between GSTM1 and GSTT1 null polymorphism with T2DM (GSTM1; OR=1.37;95% CI =1.10-1.70 and GSTT1; OR=1.29;95% CI =1.04-1.61) with an amplified risk of 2.02 fold for combined GSTM1-GSTT1 null genotypes. Furthermore, the GSTT1 null (OR=1.56;95%CI=1.38-1.77) and combined GSTM1-GSTT1 null genotypes (OR=1.91;95%CI=1.25- 2.94) increased the risk for development of T2DM related complications, but not the GSTM1 null genotype. Stratified analyses based on ethnicity revealed GSTM1 and GSTT1 null genotypes increase the risk for T2DM in both Caucasians and Asians, with Asians showing much higher risk of T2DM complications than Caucasians for the same. </P><P> Discussion: GSTM1, GSTT1 and combined GSTM1-GSTT1 null polymorphism may be associated with increased risk for T2DM; while GSTT1 and combined GSTM1-GSTT1 null polymorphism may increase the risk of subsequent development of T2DM complications with Asian population carrying an amplified risk for the polymorphism.Conclusion:Thus GSTM1 and GSTT1 null genotypes increases the risk for Type 2 diabetes mellitus alone, in combination or with regards to ethnicity.

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