Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes

BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events

Exercise improves quality of life in indigenous polynesian peoples with type 2 diabetes and visceral obesity

Background: To evaluate the differential effect of 2, group-based exercise modalities on quality of life (QoL) in indigenous Polynesian peoples with type 2 diabetes (T2DM) and visceral obesity. Methods: Participants were randomized to resistance training or aerobic training performed 3 times per for 16 weeks. The Short-Form 36 was administered at baseline and post intervention to assess 8 domains and physical and mental component scales (PCS and MCS) of QoL. Results: With the exception of Mental Health and MCS, all scores were lower at baseline than general population norms. Significant improvements were documented in several QoL scores in each group post intervention. No group × time interactions were noted. Pooled analyses of the total cohort indicated significantly improved Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality, Role-Emotional, PCS and MCS. Adaptation ranged from 5%–22%, and demonstrated a moderate-to-large effect (Cohen’s d = 0.64–1.29). All measures of QoL increased to near equivalent, or greater than general norms. Conclusion: Exercise, regardless of specific modality, can improve many aspects of QoL in this population. Robust trials are required to investigate factors mediating improvements in QoL, and create greater advocacy for exercise as a QoL intervention in this and other indigenous populations with T2DM

South Pacific Islanders resist type 2 diabetes : comparison of aerobic and resistance training

The purpose of this study was to evaluate the effectiveness of two exercise modalities for improving glycosylated hemoglobin (HbA1c) and associated clinical outcomes in Polynesian adults diagnosed with type 2 diabetes and visceral obesity. Twenty-six adults were randomized to receive resistance training or aerobic training, 3x/week, for 16 weeks. Dependent variables collected before and after intervention included: diabetes markers including HbA1c, blood lipids, relevant cytokines (C-reactive protein, adiponectin), and anthropometric and hemodynamic indices. Eighteen participants (72% female; age: 49.3 ± 5.3 years; waist circumference: 128.7 ± 18.7 cm) completed the intervention and follow-up assessments. Body mass index in the whole cohort at baseline indicated Class III (morbid) obesity (43.8 ± 9.5 kg/m2). Compliance to training was 73 ± 19 and 67 ± 18% in the aerobic and resistance training groups, respectively. HbA1c remained elevated in both groups after training. Aerobic training reduced systolic and diastolic blood pressure and increased serum triglycerides (all P < 0.05). No other exercise-induced adaptations were noted within or between groups. Post hoc analysis using pooled data indicated that higher adherence to training (≥75% attendance, n = 8) significantly reduced waist circumference (P < 0.001) and tended to reduce body weight and fasting insulin (all P ≤ 0.11) versus lower adherence (<75% attendance, n = 10). In conclusion, this study did not demonstrate an improvement in HbA1c with exercise in morbidly obese Polynesian people. Future investigations involving exercise regimens that are more practicable and which involve greater frequency and duration of training may be required to induce significant and clinically meaningful adaptations in this unique diabetes population

Effect of aerobic exercise on leptin and PGC-1α gene expression in a unique cohort of morbidly obese Polynesians with type 2 diabetes

Incidence of type 2 diabetes (T2D) and obesity is rapidly escalating in New Zealand, particularly in Polynesians. Aerobic (AER) exercise can improve body composition, glycaemic control, and alter circulating metabolic hormones in individuals with T2D. PGC-1α is a key regulator in energy metabolism, controlling adaptive thermogenesis and glucose/fatty acid metabolism, and has been implicated in the pathogenesis of T2D. We have a unique cohort of morbidly obese Polynesian New Zealanders with T2D that have undergone intensive exercise training in the SPIRIT study. We are interested in examining the impact of exercise on energy metabolism in the skeletal muscle (SM) of this unique cohort

Influence of aerobic and resistance exercise training on mitochondrial activity and density of skeletal muscle tissue of Polynesian individuals with type 2 diabetes and morbid obesity

Several studies have demonstrated that mitochondrial activity and lipid metabolism in skeletal muscle (SM) of people with T2DM declines. Outcomes with exercise trials on people with type 2 diabetes and insulin resistance show that exercise has the ability to increase both lipid oxidation and mitochondrial oxidative capacity of the SM. A randomised trial of 16 weeks progressive resistance training (PRT) or aerobic exercise (AER) training in a cohort of Polynesian New Zealanders with type 2 diabetes mellitus (T2DM) and morbid obesity (n=18; BMI 43.8 ± 9.5 kg/m2; mean waist circumference 128.7 ± 18.7 cm) was performed

Анализ временных рядов кардиограмм для пациентов с нормальным ритмом сердца с помощью усредненных оценок смешанного момента и смешанного семиинварианта четвертого порядка

Работа посвящена применению усредненных оценок смешанного момента и смешанного семиинварианта 4-го порядка к анализу кардиологических временных рядов (R-R интервалов) для пациентов с нормальным ритмом сердца, с целью выявления скрытых периодов